{ "hospital_name": "Central Maine Medical Center", "last_updated_on": "2026-04-29", "version": "3.0", "location_name": [ "Central Maine Medical Center" ], "hospital_address": [ "300 Main Street, Lewiston, ME 04240" ], "license_information": { "license_number": "40000", "state": "ME" }, "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Allen Stefanek" }, "type_2_npi": [ "1689653487", "1073651576" ], "standard_charge_information": [ { "description": "Insulin Regular (Human) Inj 100 Unit/ML - 00002821501 - 25000001", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00002821501", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Levofloxacin in D5W IV Soln 750 MG/150ML", "drug_information": { "unit": 150.0, "type": "ML" }, "code_information": [ { "code": "00409444401", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.2145, "maximum": 2.2145, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.21 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.73, "10th_percentile": 21.73, "90th_percentile": 21.73, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L0150) CERV SEMI-RIG ADJ MOLDED CHN", "code_information": [ { "code": "L0150", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 141.0, "minimum": 137.6749, "maximum": 239.5923, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 172.09, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 137.67, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 239.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C9358) SURGIMEND, FETAL", "code_information": [ { "code": "C9358", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 43.4515, "maximum": 43.4515, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.45 } ] } ] }, { "description": "HC (SUP SHELL C9362) IMPLNT,BON VOID FILLER-STRIP", "code_information": [ { "code": "C9362", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 225.0835, "maximum": 225.0835, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.08 } ] } ] }, { "description": "HC R&L HEART CATH INJ VETRICULOGRAPHY, RS/I", "code_information": [ { "code": "93453", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IGG 1 2 3 OR 4 EACH", "code_information": [ { "code": "82787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.5, "discounted_cash": 8.0, "minimum": 7.7938, "maximum": 71.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 143.4, "10th_percentile": 143.4, "90th_percentile": 143.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 181.0, "10th_percentile": 181.0, "90th_percentile": 296.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THROAT SURGERY PROCEDURE", "code_information": [ { "code": "42999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1160.94, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 1118.4181, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1118.42, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 894.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ESTRIOL", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.38, "discounted_cash": 24.0, "minimum": 23.4981, "maximum": 313.3794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TOPIRAMATE", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.31, "discounted_cash": 11.0, "minimum": 11.5839, "maximum": 183.3903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Chloroprocaine HCl Preservative Free (PF) Inj 3%", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323047801", "type": "NDC" }, { "code": "J2401", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL Q4121) THERASKIN", "code_information": [ { "code": "Q4121", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 111.3485, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 80 MG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00075062201", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.118, "maximum": 1.118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.12 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [ { "code": "805", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9255.0, "minimum": 6907.49, "maximum": 19500.9713, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 11327.68, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12524.12, "10th_percentile": 12524.12, "90th_percentile": 12524.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19500.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 11005.89, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11511.62, "10th_percentile": 11511.62, "90th_percentile": 11511.62, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11317.95 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9255.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6907.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9255.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11318.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9255.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12002.52 } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "854", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16244.0, "minimum": 13829.51, "maximum": 54222.2694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 48812.48, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 57996.71, "10th_percentile": 57996.71, "90th_percentile": 57996.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36105.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 46138.67, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 35793.77, "10th_percentile": 35793.77, "90th_percentile": 35793.77, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30364.98 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16244.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13829.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16244.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30365.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16244.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22222.23 } ] } ] }, { "description": "HC BCR/ABL1 GENE MINOR BP", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1550.31, "discounted_cash": 144.0, "minimum": 140.7555, "maximum": 1351.8703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.94, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.76, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 760.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 244.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Butorphanol Tartrate Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409162621", "type": "NDC" }, { "code": "J0595", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.0835, "maximum": 10.0835, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.08 } ] } ] }, { "description": "HC (SUP SHELL A6207) CONTACT LAYER >16<= 48 SQ IN", "code_information": [ { "code": "A6207", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 10.1747, "maximum": 17.7069, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELLQ4237) CRYO-CORD, PER SQ CM", "code_information": [ { "code": "Q4237", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 912.6105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 912.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "756", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8353.0, "minimum": 6609.87, "maximum": 20773.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17356.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20773.27 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6609.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20773.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10682.37 } ] } ] }, { "description": "HC EVAL C/V AMNIOTIC FLUD PROTEIN QUAL EA SPECIMEN", "code_information": [ { "code": "84112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.81, "discounted_cash": 98.0, "minimum": 72.843, "maximum": 242.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 130.54, "10th_percentile": 130.54, "90th_percentile": 130.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.17, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 95.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 194.25, "10th_percentile": 194.25, "90th_percentile": 194.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 169.39, "10th_percentile": 169.39, "90th_percentile": 341.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ELECTROLYTE PANEL", "code_information": [ { "code": "80051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.13, "discounted_cash": 7.0, "minimum": 6.8123, "maximum": 103.0094, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 63.57, "10th_percentile": 63.57, "90th_percentile": 63.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 31.33, "10th_percentile": 31.33, "90th_percentile": 31.33, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 78.54, "10th_percentile": 78.54, "90th_percentile": 78.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 89.25, "10th_percentile": 89.25, "90th_percentile": 89.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MASTECTOMY FOR MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "583", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14162.0, "minimum": 11369.67, "maximum": 56858.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31159.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56858.6 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11369.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56858.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19178.22 } ] } ] }, { "description": "HC OPEN/PERQ PLACEMENT INTRAVASCULAR STNT SAME 1ST", "code_information": [ { "code": "37238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39143.8, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 39143.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39143.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39143.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39143.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF AMMONIA", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 305.94, "discounted_cash": 14.0, "minimum": 14.1591, "maximum": 266.7797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 328.94, "10th_percentile": 328.94, "90th_percentile": 328.94, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.7, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 164.64, "10th_percentile": 164.64, "90th_percentile": 167.8, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT HUMERAL SUPRACONDYLAR FX WO MANIP", "code_information": [ { "code": "24530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.75, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 878.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITH MCC", "code_information": [ { "code": "796", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9923.0, "minimum": 7343.53, "maximum": 25238.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21087.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25238.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9923.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7343.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9923.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25238.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9923.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12979.0 } ] } ] }, { "description": "HC MUSCULOSKELETAL NUCLEAR EXAM", "code_information": [ { "code": "78399", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1413.44, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1413.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1413.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1413.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1413.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT HEEL FX W MANIP", "code_information": [ { "code": "28405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [ { "code": "902", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15608.0, "minimum": 13133.92, "maximum": 40393.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34594.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40393.12 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13133.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40393.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21292.46 } ] } ] }, { "description": "HC (SUP SHELL A4353) INTERMITTENT URINARY CATH", "code_information": [ { "code": "A4353", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 9.6888, "maximum": 16.8613, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15231.0, "minimum": 12848.06, "maximum": 57764.4749, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 52001.28, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15945.18, "10th_percentile": 15945.18, "90th_percentile": 15945.18, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33698.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32969.93 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15231.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12848.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32969.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15231.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20740.82 } ] } ] }, { "description": "HC REPR WND INTRMD FACE 7.6-12.5 CM", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7507) INTEGRATED FILTER & HOLDER", "code_information": [ { "code": "A7507", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.4596, "maximum": 6.0207, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.32, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC QUANTITATIVE SCREEN, METALS", "code_information": [ { "code": "83018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.94, "discounted_cash": 21.0, "minimum": 21.3407, "maximum": 100.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4629) TRACHEOSTOMY CARE KIT - A4629 - RU272069", "code_information": [ { "code": "A4629", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.443, "maximum": 11.2127, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITH CC", "code_information": [ { "code": "908", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16222.0, "minimum": 13961.01, "maximum": 86590.8208, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36052.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 75975.5, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 194291.5, "10th_percentile": 194291.5, "90th_percentile": 194291.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33347.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13961.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33347.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 86590.82, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 86474.26, "10th_percentile": 86474.26, "90th_percentile": 86474.26, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22189.98 } ] } ] }, { "description": "HC UNLISTED PROCEDURE LIPS", "code_information": [ { "code": "40799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1227.5, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 1118.4181, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1118.42, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 894.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROLONGED IV INF, REQ PUMP - C8957 - 26100001 - 26100001", "code_information": [ { "code": "C8957", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1091.25, "discounted_cash": 209.0, "minimum": 209.87, "maximum": 1004.3749, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 826.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1004.37, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 803.53, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 354.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4373) SKIN BARRIER WITH FLANGE", "code_information": [ { "code": "A4373", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.6879, "maximum": 15.1193, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECTION; SPIDER VEINS,LIMB/TRUNK", "code_information": [ { "code": "36468", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 598.44, "discounted_cash": 401.0, "minimum": 179.532, "maximum": 598.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 598.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 598.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 598.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 598.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE", "code_information": [ { "code": "10030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 790.0, "discounted_cash": 698.0, "minimum": 237.0, "maximum": 790.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 790.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 790.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 790.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 790.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH", "code_information": [ { "code": "86807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 578.75, "discounted_cash": 78.0, "minimum": 76.4321, "maximum": 504.67, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.01, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.54, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 76.43, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 412.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC VEEG BY TECH 2-12 HR CONTINUOUS R-T MONITORNG", "code_information": [ { "code": "95713", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2078.75, "discounted_cash": 368.0, "minimum": 368.19, "maximum": 1812.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1450.52, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1762.05, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1409.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 401.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [ { "code": "794", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12272.0, "minimum": 4437.1699, "maximum": 60283.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 5936.9, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4045.18, "10th_percentile": 1059.76, "90th_percentile": 19615.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26669.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 5768.25, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7127.62, "10th_percentile": 7127.62, "90th_percentile": 7127.62, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 5786.4, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5642.72, "10th_percentile": 2781.86, "90th_percentile": 13236.93, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 60283.79 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 6579.75, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5346.4, "10th_percentile": 5346.4, "90th_percentile": 5346.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12272.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10217.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12272.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60283.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 6594.87, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4115.56, "10th_percentile": 1472.42, "90th_percentile": 12277.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12272.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16414.49 } ] } ] }, { "description": "HC PRQ DRUG ELUTING COR REVASC W AMI S - 92941 - 48100198", "code_information": [ { "code": "92941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27935.9, "minimum": 8380.77, "maximum": 27935.9, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27935.9 } ] } ] }, { "description": "Cefazolin Sodium-Dextrose IV Solution 2 GM/100ML-4%", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338350841", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7845, "maximum": 1.7845, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.87, "10th_percentile": 11.99, "90th_percentile": 26.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.78 } ] } ] }, { "description": "HC MR SAFETY MED PHYSICS XM CUSTOMIZATION PLNG&MNTR", "code_information": [ { "code": "76017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 906.56, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 906.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 906.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC AMPUTATION TOE INTERPHALANGEAL JOINT", "code_information": [ { "code": "28825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7192.19, "discounted_cash": 3228.0, "minimum": 2157.657, "maximum": 7192.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7192.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7192.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7192.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5054) CLSD OSTOMY POUCH W/FLANGE", "code_information": [ { "code": "A5054", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4878, "maximum": 4.3295, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.49, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4265) PARAFFIN", "code_information": [ { "code": "A4265", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.7229, "maximum": 8.2192, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SEMEN ANALYSIS STRICT MORPHOLOGIC CRITERIA", "code_information": [ { "code": "89322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 384.06, "discounted_cash": 15.0, "minimum": 15.0629, "maximum": 334.9003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 194.71, "10th_percentile": 194.71, "90th_percentile": 194.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Mepivacaine HCl Preservative Free (PF) Inj 2%", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323029401", "type": "NDC" }, { "code": "J0670", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.8045, "maximum": 7.8045, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.8 } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CCMCC", "code_information": [ { "code": "179", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6790.0, "minimum": 5327.35, "maximum": 22014.5444, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13642.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11814.77 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6790.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5327.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6790.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11814.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6790.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8396.87 } ] } ] }, { "description": "HC SMEAR COMPLEX STAIN", "code_information": [ { "code": "87209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.75, "discounted_cash": 17.0, "minimum": 17.473, "maximum": 147.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 101.8, "10th_percentile": 101.8, "90th_percentile": 101.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 81.06, "10th_percentile": 81.06, "90th_percentile": 81.06, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 87.24, "10th_percentile": 87.24, "90th_percentile": 90.81, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 80.37, "10th_percentile": 80.37, "90th_percentile": 80.37, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 111.98, "10th_percentile": 94.04, "90th_percentile": 265.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "419", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11435.0, "minimum": 9119.54, "maximum": 37215.3328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24679.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 32550.61, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 30565.32, "10th_percentile": 30565.32, "90th_percentile": 30565.32, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31089.76 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11435.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9119.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11435.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31089.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11435.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15189.99 } ] } ] }, { "description": "HC CLSD TREAT ELBOW DISLOC W ANES", "code_information": [ { "code": "24605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2052.81, "discounted_cash": 1586.0, "minimum": 615.843, "maximum": 2052.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OPEN TREAT DIST PHALANGEAL FX EA", "code_information": [ { "code": "26765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4149.69, "discounted_cash": 3228.0, "minimum": 1244.907, "maximum": 4149.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL", "code_information": [ { "code": "77047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1235.31, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1235.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1235.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11576.0, "minimum": 10450.52, "maximum": 29940.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25015.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29940.24 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11576.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10450.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11576.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29940.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11576.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15396.85 } ] } ] }, { "description": "HC ERCP,BIOPSY", "code_information": [ { "code": "43261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6436.56, "discounted_cash": 3804.0, "minimum": 1930.968, "maximum": 6436.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6436.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6436.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6436.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4146.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6433.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PULMONARY STRESS TESTING, COMPLEX", "code_information": [ { "code": "94621", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 982.19, "discounted_cash": 368.0, "minimum": 294.657, "maximum": 982.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 982.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 982.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 401.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NASOPHARYNGOSCOPY WITH ENDOSCOPE", "code_information": [ { "code": "92511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.13, "discounted_cash": 196.0, "minimum": 74.439, "maximum": 248.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 248.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 248.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [ { "code": "153", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6662.0, "minimum": 4925.91, "maximum": 13339.1559, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 9564.18, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8139.57, "10th_percentile": 8139.57, "90th_percentile": 8139.57, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13339.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8455.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6662.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4925.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8455.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6662.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8210.02 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 92448.0, "minimum": 88751.4, "maximum": 236027.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 217161.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 236026.61 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 92448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90681.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 92448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 236027.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 92448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 133659.24 } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "465", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14918.0, "minimum": 12016.12, "maximum": 43845.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32953.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43845.6 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14918.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12016.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14918.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43845.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 31785.66, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 31645.6, "10th_percentile": 31645.6, "90th_percentile": 31645.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14918.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20282.61 } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "022", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25213.0, "minimum": 19116.71, "maximum": 68716.24, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35338.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57415.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 68716.24 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19116.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68716.2 } ] } ] }, { "description": "HC TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL", "code_information": [ { "code": "59812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2415.63, "discounted_cash": 3194.0, "minimum": 724.689, "maximum": 2415.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 6073.7, "10th_percentile": 6073.7, "90th_percentile": 6073.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAIN BLOOD FROM UNDER NAIL", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.0, "discounted_cash": 131.0, "minimum": 61.5, "maximum": 205.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1896) LEAD AICD NON SING/DUAL", "code_information": [ { "code": "C1896", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 13911.97, "10th_percentile": 13911.97, "90th_percentile": 13911.97, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6243) HYDROGEL DRG >16<=48 W/O BDR", "code_information": [ { "code": "A6243", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 17.0, "minimum": 17.0648, "maximum": 29.6975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.33, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CMV ANTIBODY", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.25, "discounted_cash": 14.0, "minimum": 13.9842, "maximum": 197.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 125.4, "10th_percentile": 125.4, "90th_percentile": 125.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "853", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38607.0, "minimum": 34615.65, "maximum": 122246.2931, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 89239.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 84199.74 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 38607.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34615.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38607.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 84199.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 38607.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54925.53 } ] } ] }, { "description": "HC (SUP SHELL A4614) HAND-HELD PEFR METER", "code_information": [ { "code": "A4614", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 33.0, "minimum": 32.9343, "maximum": 57.3148, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.17, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.93, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine HCl Tab 50 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "70000061601", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A6446) CONFORM BAND S W>=3 <5/YD - A6446 - RU272064", "code_information": [ { "code": "A6446", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CALCIUM, IONIZED", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.94, "discounted_cash": 13.0, "minimum": 13.2942, "maximum": 205.7397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 151.0, "10th_percentile": 151.0, "90th_percentile": 151.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 129.41, "10th_percentile": 129.41, "90th_percentile": 129.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 164.59, "10th_percentile": 164.59, "90th_percentile": 164.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9080.0, "minimum": 7404.44, "maximum": 23486.3249, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19085.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 20542.45, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16084.56, "10th_percentile": 16084.56, "90th_percentile": 16084.56, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17480.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9080.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7404.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9080.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17480.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9080.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11746.72 } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [ { "code": "486", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16951.0, "minimum": 14679.45, "maximum": 43216.0787, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37785.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36056.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14679.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36056.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23256.55 } ] } ] }, { "description": "HC (SUP SHELL A6223) GAUZE >16<=48 NO W/SAL W/O B - A6223 - 27200127", "code_information": [ { "code": "A6223", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.3624, "maximum": 5.8516, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.36, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Digoxin Inj 0.25 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00781305972", "type": "NDC" }, { "code": "J1160", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.492, "maximum": 10.492, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.49 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15272.0, "minimum": 13369.24, "maximum": 57018.5336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33796.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30236.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15272.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13369.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15272.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30236.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15272.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20800.88 } ] } ] }, { "description": "HC (SUP SHELL C1760) CLOSURE DEVICE VASCULAR", "code_information": [ { "code": "C1760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 773.68, "10th_percentile": 773.68, "90th_percentile": 773.68, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4186) EPIFIX PER SQ CM", "code_information": [ { "code": "Q4186", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9", "code_information": [ { "code": "81219", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1601.56, "discounted_cash": 121.0, "minimum": 118.2, "maximum": 1396.5603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.74, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.2, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 638.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 132.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4138) BIODFENCE DRYFLEX, 1CM", "code_information": [ { "code": "Q4138", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Clindamycin Phosphate in D5W IV Soln 900 MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338381450", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.4615, "maximum": 3.4615, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.46 } ] } ] }, { "description": "Epoetin Alfa Inj 20000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55513047801", "type": "NDC" }, { "code": "J0885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.305, "maximum": 28.7788, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.37, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4557) LEAD WIRES, PAIR", "code_information": [ { "code": "A4557", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 13.0, "minimum": 12.7403, "maximum": 22.1716, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMAG,ACUTE VENOUS THRMBSIS,UNILAT", "code_information": [ { "code": "78457", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1004.38, "discounted_cash": 535.0, "minimum": 301.314, "maximum": 1004.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1004.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Amino Acid Infusion 4.25% in D5W", "drug_information": { "unit": 2000.0, "type": "ML" }, "code_information": [ { "code": "00338108904", "type": "NDC" }, { "code": "J7070", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.826, "maximum": 7.826, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83 } ] } ] }, { "description": "Azithromycin For Susp 200 MG/5ML", "drug_information": { "unit": 23.0, "type": "ML" }, "code_information": [ { "code": "42806015033", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.1585, "maximum": 54.1585, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.16 } ] } ] }, { "description": "HC EXCHANGE NEPHROSTOMY CATH, PERQ", "code_information": [ { "code": "50435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3556.25, "discounted_cash": 2062.0, "minimum": 1066.875, "maximum": 3556.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3556.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3556.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3556.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 2077.1, "10th_percentile": 2077.1, "90th_percentile": 2077.1, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2480.84, "10th_percentile": 2480.84, "90th_percentile": 2480.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEST X-RAY 2 VW", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.06, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 319.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 204.2, "10th_percentile": 171.53, "90th_percentile": 204.2, "count": "37" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 922.15, "10th_percentile": 922.15, "90th_percentile": 922.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 92.04, "10th_percentile": 92.04, "90th_percentile": 171.53, "count": "21" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 222.58, "10th_percentile": 201.03, "90th_percentile": 224.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [ { "code": "467", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27869.0, "minimum": 23706.94, "maximum": 125395.9357, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 75178.91 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 27869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23706.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75178.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 27869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39221.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 63725.1 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23454.0, "minimum": 20052.48, "maximum": 59105.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 53235.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 59105.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23454.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20052.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23454.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59105.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 23454.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32765.58 } ] } ] }, { "description": "HC ASSAY VIT D, 1,25-DIHYDROXY W FRACTIONS", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 448.44, "discounted_cash": 38.0, "minimum": 37.4143, "maximum": 391.0397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 172.1, "10th_percentile": 172.1, "90th_percentile": 172.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.77, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.41, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 241.33, "10th_percentile": 241.33, "90th_percentile": 245.96, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 312.83, "10th_percentile": 201.36, "90th_percentile": 315.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.11, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "581", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12023.0, "minimum": 9961.18, "maximum": 47144.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26076.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47144.14 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9961.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47144.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16049.7 } ] } ] }, { "description": "HC (SUP SHELL A6199) ALGINATE DRSG WOUND FILLER", "code_information": [ { "code": "A6199", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.3079, "maximum": 12.7178, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR", "code_information": [ { "code": "34709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6033.13, "minimum": 1809.939, "maximum": 6033.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6033.13 } ] } ] }, { "description": "HC (SUP SHELL A5071) URINARY POUCH W/BARRIER", "code_information": [ { "code": "A5071", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.3283, "maximum": 14.4936, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL TUNLD CV CATH W SUBQ PORT/PUMP", "code_information": [ { "code": "36590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5641.88, "discounted_cash": 1553.0, "minimum": 1553.22, "maximum": 5641.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5641.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5641.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5641.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 3620.37, "10th_percentile": 3620.37, "90th_percentile": 3620.37, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 3499.08, "10th_percentile": 3499.08, "90th_percentile": 3499.08, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1809.22, "10th_percentile": 1809.22, "90th_percentile": 1809.22, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3450.47, "10th_percentile": 3450.47, "90th_percentile": 3450.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF G6PD ENZYME", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.63, "discounted_cash": 9.0, "minimum": 9.4265, "maximum": 70.3094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.43, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 41.09, "10th_percentile": 41.09, "90th_percentile": 41.09, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 44.22, "10th_percentile": 44.22, "90th_percentile": 44.22, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.24, "10th_percentile": 50.9, "90th_percentile": 56.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC", "code_information": [ { "code": "660", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11100.0, "minimum": 9274.58, "maximum": 31157.4768, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 28048.88, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 21796.14, "10th_percentile": 21796.14, "90th_percentile": 21796.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23882.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23931.54 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11100.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9274.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11100.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23931.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11100.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14699.52 } ] } ] }, { "description": "HC INTRO CATH DIALYSIS CIRC DX ANGRPH FLUOR S&I", "code_information": [ { "code": "36901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3139.69, "discounted_cash": 1553.0, "minimum": 941.907, "maximum": 3139.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3139.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3139.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3139.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 3009.48, "10th_percentile": 3009.48, "90th_percentile": 3159.93, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TCAT INS/RPL PERM LDLS PM W/IG", "code_information": [ { "code": "33274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88901.3, "discounted_cash": 19005.0, "minimum": 19005.55, "maximum": 88901.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74874.26, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88901.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72766.55, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20716.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32142.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "358", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11679.0, "minimum": 9379.09, "maximum": 27820.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25259.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27820.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11679.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9379.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11679.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27820.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11679.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15547.0 } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "250", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17646.0, "minimum": 16006.27, "maximum": 72452.5616, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39437.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 45741.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17646.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16006.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17646.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45741.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17646.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24273.07 } ] } ] }, { "description": "HC ASSAY OF SERUM POTASSIUM", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.19, "discounted_cash": 4.0, "minimum": 4.6258, "maximum": 32.4297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 21.17, "10th_percentile": 19.99, "90th_percentile": 25.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 18.95, "10th_percentile": 18.95, "90th_percentile": 20.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 21.6, "10th_percentile": 20.01, "90th_percentile": 21.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.28, "10th_percentile": 21.28, "90th_percentile": 21.28, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 26.18, "10th_percentile": 26.18, "90th_percentile": 27.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RED BLOOD CELLS, PER UNIT", "code_information": [ { "code": "P9021", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.5, "discounted_cash": 149.0, "minimum": 149.83, "maximum": 1528.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 590.27, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 717.04, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 573.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 253.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BRACH ARTERY EXPOS DPLMNT AORTIC/ILIAC PROSTH UNI", "code_information": [ { "code": "34834", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1532.81, "minimum": 459.843, "maximum": 1532.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 1532.81 } ] } ] }, { "description": "Levothyroxine Sodium For IV Inj 100 MCG", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323088510", "type": "NDC" }, { "code": "J0650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 15.609, "maximum": 15.609, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.61 } ] } ] }, { "description": "HC GLYCOSYLATED HEMOGLOBIN TEST", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.88, "discounted_cash": 9.0, "minimum": 9.4362, "maximum": 154.2394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 113.2, "10th_percentile": 113.2, "90th_percentile": 113.2, "count": "158" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.79, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 90.14, "10th_percentile": 90.14, "90th_percentile": 123.39, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 97.01, "10th_percentile": 95.19, "90th_percentile": 97.01, "count": "266" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 43.4, "10th_percentile": 43.4, "90th_percentile": 113.2, "count": "83" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 124.52, "10th_percentile": 124.52, "90th_percentile": 124.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF HOMOCYSTINE", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326.25, "discounted_cash": 17.0, "minimum": 17.4147, "maximum": 284.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 175.39, "10th_percentile": 175.39, "90th_percentile": 175.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.41, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 166.26, "10th_percentile": 166.26, "90th_percentile": 166.26, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 175.57, "10th_percentile": 175.57, "90th_percentile": 178.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 80.1, "10th_percentile": 80.1, "90th_percentile": 208.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 94.03, "10th_percentile": 94.03, "90th_percentile": 94.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj PF 125 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009004725", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 43.31, "10th_percentile": 43.31, "90th_percentile": 159.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 51.04, "10th_percentile": 51.04, "90th_percentile": 53.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "count": "1 through 10" } ] } ] }, { "description": "Hydromorphone HCl-NaCl Soln Pref Syr 25 MG/50ML-0.9%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "09999408226", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.98, "10th_percentile": 11.99, "90th_percentile": 39.11, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 44.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "HC PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY", "code_information": [ { "code": "92972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13833.8, "minimum": 4150.14, "maximum": 12063.0736, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 28117.51, "10th_percentile": 28117.51, "90th_percentile": 28117.51, "count": "1 through 10" } ] } ] }, { "description": "Piperacillin Sod-Tazobactam Sod For Inj 2.25 GM (2-0.25 GM)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55150011930", "type": "NDC" }, { "code": "J2543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.408, "maximum": 2.408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 72.41, "10th_percentile": 72.41, "90th_percentile": 72.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.41 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 85.34, "10th_percentile": 85.34, "90th_percentile": 170.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 99.93, "10th_percentile": 99.93, "90th_percentile": 99.93, "count": "1 through 10" } ] } ] }, { "description": "HC RENAL IMAGING WITH FLOW", "code_information": [ { "code": "78701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 788.13, "discounted_cash": 394.0, "minimum": 236.439, "maximum": 788.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 788.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 788.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 788.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NON-INVASIVE LOWR EXTRM ART STRSS/REST COMPLT BILAT", "code_information": [ { "code": "93924", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 910.31, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 910.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 910.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY ANKLE 3+ VW", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 483.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 421.5597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 291.8, "10th_percentile": 245.11, "90th_percentile": 291.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 231.25, "10th_percentile": 231.25, "90th_percentile": 231.25, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 294.97, "10th_percentile": 283.56, "90th_percentile": 294.97, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 110.5, "10th_percentile": 110.5, "90th_percentile": 110.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 320.98, "10th_percentile": 296.48, "90th_percentile": 337.25, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR VESSEL DIRECT LOWER EXTREM", "code_information": [ { "code": "35226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4921.25, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 4291.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3343.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Mycophenolate Mofetil Cap 250 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60687088511", "type": "NDC" }, { "code": "J7517", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "718", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11262.0, "minimum": 8526.39, "maximum": 24269.6021, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24269.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17147.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8526.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17147.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14937.53 } ] } ] }, { "description": "HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION", "code_information": [ { "code": "87536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 790.0, "discounted_cash": 85.0, "minimum": 82.7002, "maximum": 688.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 477.0, "10th_percentile": 477.0, "90th_percentile": 477.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.7, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 408.79, "10th_percentile": 408.79, "90th_percentile": 425.15, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 446.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 380.4, "10th_percentile": 380.4, "90th_percentile": 380.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 551.1, "10th_percentile": 551.1, "90th_percentile": 551.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR TONGUE LACER,<2.6 CM", "code_information": [ { "code": "41250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 540.63, "discounted_cash": 440.0, "minimum": 162.189, "maximum": 540.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 540.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 540.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 540.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 540.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ MECHAN THROMBECTOMY VENOUS", "code_information": [ { "code": "37187", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12674.1, "discounted_cash": 11390.0, "minimum": 3802.23, "maximum": 12674.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12674.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12674.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12674.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12674.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "512", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13638.0, "minimum": 11128.11, "maximum": 47369.9612, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29912.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31559.32 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13638.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11128.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13638.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31559.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13638.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18410.83 } ] } ] }, { "description": "HC CLSD TREAT PROX/MID FING SHFT FX W MANIP EA", "code_information": [ { "code": "26725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 452.19, "discounted_cash": 243.0, "minimum": 135.657, "maximum": 452.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 452.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 452.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 452.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC", "code_information": [ { "code": "510", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24020.0, "minimum": 19781.85, "maximum": 67794.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 54579.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 67794.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24020.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19781.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24020.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67794.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24020.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33593.03 } ] } ] }, { "description": "HC REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES", "code_information": [ { "code": "30310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2236.88, "discounted_cash": 3271.0, "minimum": 671.064, "maximum": 2236.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4101) APLIGRAF PER SQ CM", "code_information": [ { "code": "Q4101", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 65.274, "maximum": 605.4868, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [ { "code": "823", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35917.0, "minimum": 32388.36, "maximum": 102093.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 82846.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 102093.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35917.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32388.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35917.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 102093.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 35917.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50990.68 } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [ { "code": "974", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22997.0, "minimum": 20668.48, "maximum": 52149.5582, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 52149.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37180.3 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22997.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20668.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22997.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37180.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22997.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32097.17 } ] } ] }, { "description": "HC OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS", "code_information": [ { "code": "98925", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.44, "discounted_cash": 21.0, "minimum": 21.31, "maximum": 142.5197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.95, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX", "code_information": [ { "code": "37212", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3611.56, "discounted_cash": 3115.0, "minimum": 1083.468, "maximum": 3611.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COMPATIBILITY TEST,SPIN TECH", "code_information": [ { "code": "86920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.63, "discounted_cash": 168.0, "minimum": 31.689, "maximum": 105.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5466.47, "maximum": 5466.47, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5466.47 } ] } ] }, { "description": "HEADACHES WITH MCC", "code_information": [ { "code": "102", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9572.0, "minimum": 8025.28, "maximum": 31304.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20254.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31304.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9572.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8025.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9572.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31304.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9572.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12466.29 } ] } ] }, { "description": "HC ELECTRIC CURRENT THER, IONTOPHORESIS EA 15 MIN", "code_information": [ { "code": "97033", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.75, "discounted_cash": 18.0, "minimum": 17.5993, "maximum": 112.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ XHEPATIC PORTOGRAM", "code_information": [ { "code": "75887", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3955.63, "discounted_cash": 3115.0, "minimum": 640.6242, "maximum": 3955.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3955.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3955.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3955.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3955.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "730", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6158.0, "minimum": 4200.56, "maximum": 14532.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12142.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14532.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6158.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4200.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6158.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14532.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6158.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7473.77 } ] } ] }, { "description": "Phytonadione Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "43598040511", "type": "NDC" }, { "code": "J3430", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.2675, "maximum": 5.2675, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.27 } ] } ] }, { "description": "HC REVASC INTRAVASC LITHOTRIPSY", "code_information": [ { "code": "C9764", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43887.8, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 43887.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43887.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43887.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4169) ARTACENT WOUND, PER SQ CM", "code_information": [ { "code": "Q4169", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 378.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY GLUCOSE, BODY FLUID", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.25, "discounted_cash": 3.0, "minimum": 3.8192, "maximum": 62.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 36.31, "10th_percentile": 36.31, "90th_percentile": 36.31, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 39.08, "10th_percentile": 39.08, "90th_percentile": 39.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.57, "10th_percentile": 17.57, "90th_percentile": 17.57, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13676.0, "minimum": 11506.71, "maximum": 48153.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30004.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48153.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13676.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11506.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13676.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48153.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13676.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18467.55 } ] } ] }, { "description": "HC INJ DX/THR PARAVRT FACET JNT IMG LUMB/SAC 1ST LVL", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3721.88, "discounted_cash": 872.0, "minimum": 872.7, "maximum": 3721.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1995.15, "10th_percentile": 1995.15, "90th_percentile": 1995.15, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3438.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3721.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3341.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 2992.72, "10th_percentile": 2992.72, "90th_percentile": 2992.72, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3523.07, "10th_percentile": 3523.07, "90th_percentile": 3523.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DOPPLER FETAL UMBILICAL ARTERY", "code_information": [ { "code": "76820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 516.56, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SALIVARY GLAND PROCEDURES", "code_information": [ { "code": "139", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10446.0, "minimum": 9502.99, "maximum": 26723.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22328.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26723.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10446.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9502.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10446.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26723.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10446.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13743.06 } ] } ] }, { "description": "HC (SUP SHELL A2006) NOVOSORB SYNPATH PER SQ CM", "code_information": [ { "code": "A2006", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM PARATHYROID PLANAR IMAGING", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 842.19, "discounted_cash": 394.0, "minimum": 252.657, "maximum": 842.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 842.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 842.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 842.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 842.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FERN TEST - 87210 - 30600080", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.13, "discounted_cash": 5.0, "minimum": 5.6559, "maximum": 76.8494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT ORBIT/SELLA/POST FOSSA/EAR WO/W CONTR", "code_information": [ { "code": "70482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2515.31, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2193.3503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1377.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRANSFERASE ALANINE AMINO (ALT) (SGPT)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 5.0, "minimum": 5.1505, "maximum": 78.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 69.0, "10th_percentile": 48.0, "90th_percentile": 69.0, "count": "28" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 54.94, "10th_percentile": 54.94, "90th_percentile": 54.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 58.02, "10th_percentile": 58.02, "90th_percentile": 59.13, "count": "36" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.69, "10th_percentile": 23.69, "90th_percentile": 23.69, "count": "19" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 75.21, "10th_percentile": 27.72, "90th_percentile": 75.9, "count": "47" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THROMBOLYTIC THERAPY, STROKE", "code_information": [ { "code": "37195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3243.13, "discounted_cash": 325.0, "minimum": 325.91, "maximum": 2828.0094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1283.96, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1559.71, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1247.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 551.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT PROX/MID FING SHFT FX WO MANIP EA", "code_information": [ { "code": "26720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 688.44, "discounted_cash": 243.0, "minimum": 206.532, "maximum": 688.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 688.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 688.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 688.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC TPVT ATHRC UNI SF LES 1ST VSL", "code_information": [ { "code": "37288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Rasburicase For IV Soln 1.5 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00024515010", "type": "NDC" }, { "code": "J2783", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 382.0, "minimum": 366.8739, "maximum": 1505.6639, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1505.66, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 458.57, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 366.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 796.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSIVE ENCEPHALOPATHY WITHOUT CCMCC", "code_information": [ { "code": "079", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4579.15, "maximum": 4579.15, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4579.15 } ] } ] }, { "description": "HC ALPHA-1-ANTITRYPSIN, TOTAL", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.13, "discounted_cash": 13.0, "minimum": 13.061, "maximum": 177.1294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 60.08, "10th_percentile": 60.08, "90th_percentile": 60.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 103.51, "10th_percentile": 103.51, "90th_percentile": 103.51, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 109.31, "10th_percentile": 109.31, "90th_percentile": 109.31, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 70.52, "10th_percentile": 13.44, "90th_percentile": 143.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.73, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL PERQ R HEART VAD VENOUS CANNULA SEP INSJ", "code_information": [ { "code": "33997", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2071.56, "minimum": 621.468, "maximum": 2071.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2071.56 } ] } ] }, { "description": "HC ARTHROGRAM OF KNEE JOINT", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 657.81, "discounted_cash": 344.0, "minimum": 197.343, "maximum": 657.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 657.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 657.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 657.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 657.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Regadenoson IV Inj 0.4 MG/5ML (0.08 MG/ML)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "76329332100", "type": "NDC" }, { "code": "J2785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.4815, "maximum": 9.4815, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 151.87, "10th_percentile": 151.87, "90th_percentile": 151.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.48 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 178.99, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4615) CANNULA NASAL - A4615 - RU272033", "code_information": [ { "code": "A4615", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.0107, "maximum": 1.7588, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO EXTERMITY BILAT", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10259.7, "discounted_cash": 3115.0, "minimum": 631.8398, "maximum": 10259.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 631.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEST X-RAY W APICAL LORD", "code_information": [ { "code": "71047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.06, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 319.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRUG SCREEN QUANTITATIVE LEVETIRACETAM", "code_information": [ { "code": "80177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.63, "discounted_cash": 13.0, "minimum": 12.8764, "maximum": 231.6294, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 69.53, "10th_percentile": 69.53, "90th_percentile": 185.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 160.4, "10th_percentile": 160.4, "90th_percentile": 160.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" } ] } ] }, { "description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CCMCC", "code_information": [ { "code": "537", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8305.0, "minimum": 6360.7, "maximum": 20638.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17244.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20638.84 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8305.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6360.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8305.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20638.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8305.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10613.42 } ] } ] }, { "description": "HYPERTENSION WITHOUT MCC", "code_information": [ { "code": "305", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6790.0, "minimum": 5195.84, "maximum": 16111.4503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13644.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12286.28 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6790.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5195.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6790.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12286.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6790.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8397.98 } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CCMCC", "code_information": [ { "code": "941", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16469.0, "minimum": 13526.36, "maximum": 48997.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36640.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48997.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16469.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13526.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16469.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48997.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16469.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22551.43 } ] } ] }, { "description": "HC AMNIOCENTESIS,DIAGNOSTIC", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 575.63, "discounted_cash": 908.0, "minimum": 172.689, "maximum": 575.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SINUS AND MASTOID PROCEDURES WITH CCMCC", "code_information": [ { "code": "135", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17551.0, "minimum": 16688.02, "maximum": 46929.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39211.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46929.83 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17551.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16688.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17551.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46929.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17551.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24134.05 } ] } ] }, { "description": "VIRAL ILLNESS WITH MCC", "code_information": [ { "code": "865", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12443.0, "minimum": 8879.8257, "maximum": 32063.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27074.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32063.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10039.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32063.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16663.61 } ] } ] }, { "description": "Pamidronate Disodium IV Soln 9 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "67457044610", "type": "NDC" }, { "code": "J2430", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.842, "maximum": 29.842, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.84 } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [ { "code": "207", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49986.0, "minimum": 44761.63, "maximum": 128380.8259, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 115572.19, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 50383.86, "10th_percentile": 50383.86, "90th_percentile": 50383.86, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 116274.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 112642.4, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 117750.1, "10th_percentile": 117750.1, "90th_percentile": 117750.1, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 127756.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 49986.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44761.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49986.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 127757.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 49986.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71564.67 } ] } ] }, { "description": "HC (SUP SHELL Q4010) CAST SUP SHT ARM ADULT FBRGL", "code_information": [ { "code": "Q4010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 24.0, "minimum": 24.1006, "maximum": 41.9418, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOFLUOR EA ADD SINGLE ANTIBODY STAIN", "code_information": [ { "code": "88350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.44, "minimum": 74.532, "maximum": 248.44, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.44 } ] } ] }, { "description": "HC FATS/LIPIDS, FECES, QUANTITATIVE", "code_information": [ { "code": "82710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 241.88, "discounted_cash": 16.0, "minimum": 16.3262, "maximum": 210.9194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.41, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COLORECTAL CANCER SCREEN, SIGMOID, BA ENEMA - 74270 - 32000239", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.56, "discounted_cash": 173.0, "minimum": 120.468, "maximum": 401.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 321.25, "10th_percentile": 321.25, "90th_percentile": 321.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 401.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 401.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 401.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 401.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CYCLOSPORINE", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.88, "discounted_cash": 18.0, "minimum": 17.541, "maximum": 293.7594, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.53, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Oxytocin Inj 10 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323001203", "type": "NDC" }, { "code": "J2590", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.0745, "maximum": 3.0745, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.07 } ] } ] }, { "description": "HC X-RAY GUIDE, GU DILATION", "code_information": [ { "code": "74485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10138.1, "discounted_cash": 2062.0, "minimum": 710.7578, "maximum": 9870.8891, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8125.74, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9870.89, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7897.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 710.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SALIVARY GLAND", "code_information": [ { "code": "70380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 916.88, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 799.5194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DETECT AGENT NOS, DNA, AMP", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.63, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 301.3894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 44.8, "10th_percentile": 37.63, "90th_percentile": 44.8, "count": "27" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 37.74, "10th_percentile": 37.74, "90th_percentile": 3650.0, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 39.86, "10th_percentile": 33.88, "90th_percentile": 771.64, "count": "35" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 59.25, "10th_percentile": 44.8, "90th_percentile": 627.41, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.0, "10th_percentile": 49.28, "90th_percentile": 1040.51, "count": "66" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THER IVNT COG FUNCJ CNTCT EA ADDL 15 MINUTES", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.25, "discounted_cash": 18.0, "minimum": 17.6673, "maximum": 101.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CULTURE, CHLAMYDIA", "code_information": [ { "code": "87110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 306.88, "discounted_cash": 19.0, "minimum": 19.0473, "maximum": 267.5994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ENDOVEN ABLT INCMPTNT VEIN MCHNCHEM EXTR 1ST VEIN", "code_information": [ { "code": "36473", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12432.8, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 12432.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12273.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12432.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MAMMARY DUCTOGRAM, SINGLE", "code_information": [ { "code": "77053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 533.13, "discounted_cash": 235.0, "minimum": 159.939, "maximum": 533.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 533.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 533.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 533.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 324.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1887) CATHETER GUIDING", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 80.66, "10th_percentile": 80.66, "90th_percentile": 80.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 90.08, "10th_percentile": 49.83, "90th_percentile": 164.82, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 181.17, "10th_percentile": 181.17, "90th_percentile": 181.17, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 130.8, "10th_percentile": 122.1, "90th_percentile": 517.97, "count": "1 through 10" } ] } ] }, { "description": "HC NUCLEAR THERAPY, IV", "code_information": [ { "code": "79101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 746.25, "discounted_cash": 230.0, "minimum": 223.875, "maximum": 746.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 746.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 746.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 746.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 470.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 389.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6022) COLLAGEN DRSG>16<=48 SQ IN - A6022 - RU272039", "code_information": [ { "code": "A6022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 29.0, "minimum": 29.1248, "maximum": 50.6853, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.4, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND", "code_information": [ { "code": "95811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5919.69, "discounted_cash": 847.0, "minimum": 847.32, "maximum": 5161.9697, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3244.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 923.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1432.99, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3338.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4055.02, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITH MCC", "code_information": [ { "code": "551", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13795.0, "minimum": 11810.56, "maximum": 32090.5112, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30286.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22158.54 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11810.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22158.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 32090.51, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 19557.11, "10th_percentile": 19557.11, "90th_percentile": 19557.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18641.05 } ] } ] }, { "description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [ { "code": "006", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36314.0, "minimum": 33562.91, "maximum": 106374.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 83789.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 106373.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36314.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33562.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36314.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 106374.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 36314.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51571.23 } ] } ] }, { "description": "HC PHOSPHOLIPID NEUTRALIZ, HEXAGONAL PHOSPHOLIPID", "code_information": [ { "code": "85598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.69, "discounted_cash": 17.0, "minimum": 17.473, "maximum": 108.7297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US GUIDE AMNIOCENTESIS", "code_information": [ { "code": "76946", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1071.56, "minimum": 134.529, "maximum": 934.4003, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.53 } ] } ] }, { "description": "HC (SUP SHELL A6251) ABSORPT DRG <=16 SQ IN W/O B", "code_information": [ { "code": "A6251", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.7599, "maximum": 4.803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.45, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.76, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY BLOOD CARBON MONOXIDE", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.63, "discounted_cash": 12.0, "minimum": 11.9726, "maximum": 192.3894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 64.43, "10th_percentile": 64.43, "90th_percentile": 64.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATH PLC/COR ANGIO RS/I BYPASS ANGIO", "code_information": [ { "code": "93455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine HCl Local Inj 2%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "55150025410", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.13, "90th_percentile": 25.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.7, "10th_percentile": 15.7, "90th_percentile": 15.7, "count": "1 through 10" } ] } ] }, { "description": "Filgrastim-aafi Soln Prefilled Syringe 480 MCG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00069029201", "type": "NDC" }, { "code": "Q5110", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.1188, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1781) MESH", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 867.89, "10th_percentile": 867.89, "90th_percentile": 867.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 990.06, "10th_percentile": 990.06, "90th_percentile": 1751.11, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1196.54, "10th_percentile": 1196.54, "90th_percentile": 1196.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2464.22, "10th_percentile": 1912.68, "90th_percentile": 3578.52, "count": "1 through 10" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7967.0, "minimum": 6510.2, "maximum": 20186.1024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16439.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12769.47 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7967.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6510.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7967.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12769.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7967.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10118.5 } ] } ] }, { "description": "HC REPR WND INTRMD BODY/SCALP/EXTR 12.5-20 CM", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Clevidipine IV Emulsion 25 MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "10122061001", "type": "NDC" }, { "code": "C9248", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.88, "maximum": 13.7828, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPLACE CV CATH CATHETER ONLY W SUBQ PUMP/PORT", "code_information": [ { "code": "36578", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1545.94, "discounted_cash": 3115.0, "minimum": 463.782, "maximum": 1545.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ENDOVASC INTRACRANIAL PRLNG ADMIN RX AGENT, ADDL", "code_information": [ { "code": "61651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1244.38, "minimum": 373.314, "maximum": 1244.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 1244.38 } ] } ] }, { "description": "HC MYELOGRAPHY LUMBAR INJ, LUMBOSCRAL", "code_information": [ { "code": "62304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1485.63, "discounted_cash": 773.0, "minimum": 445.689, "maximum": 1485.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1485.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1485.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1485.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 996.16, "10th_percentile": 996.16, "90th_percentile": 996.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4346) CATH INDW FOLEY 3 WAY - A4346 - 27200066", "code_information": [ { "code": "A4346", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "minimum": 23.0511, "maximum": 40.1153, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.05, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6410) STERILE EYE PAD - A6410 - RU272062", "code_information": [ { "code": "A6410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RENAL BIOPSY PERQ", "code_information": [ { "code": "50200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2355.31, "discounted_cash": 1629.0, "minimum": 706.593, "maximum": 2355.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1421.24, "10th_percentile": 1421.24, "90th_percentile": 1479.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2355.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2355.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2355.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1437.12, "10th_percentile": 1437.12, "90th_percentile": 1437.12, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1444.47, "10th_percentile": 1444.47, "90th_percentile": 1444.47, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2355.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "822", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10204.0, "minimum": 7915.93, "maximum": 26540.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21756.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26540.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10204.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7915.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10204.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26540.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10204.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13390.5 } ] } ] }, { "description": "HC REPR WND INTRMD FACE 5.1-7.5 CM", "code_information": [ { "code": "12053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRESS/DEBRIDE BURN 5-10% TTL MED", "code_information": [ { "code": "16025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 883.44, "discounted_cash": 197.0, "minimum": 197.97, "maximum": 883.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 779.92, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 883.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 757.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [ { "code": "922", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14352.0, "minimum": 11692.89, "maximum": 41262.6243, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31611.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25955.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11692.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25955.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19456.27 } ] } ] }, { "description": "HC PERQ PLCMT BILE DUCT STENT, EXISTING ACCESS", "code_information": [ { "code": "47538", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20037.2, "discounted_cash": 5965.0, "minimum": 5965.14, "maximum": 20037.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20037.2, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20037.2, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20037.2, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6502.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10088.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ERCP REMOV CALCULI/DEBRIS BILIARY/PANCREAS DUCT", "code_information": [ { "code": "43264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7151.56, "discounted_cash": 3804.0, "minimum": 2145.468, "maximum": 7151.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4146.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6433.66, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1153.08, "10th_percentile": 1153.08, "90th_percentile": 1153.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6643.0, "minimum": 5116.94, "maximum": 20387.5574, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 18353.48, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12860.37, "10th_percentile": 12860.37, "90th_percentile": 12860.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13293.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 17832.1, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18447.32, "10th_percentile": 18447.32, "90th_percentile": 18447.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 17888.21, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11914.91, "10th_percentile": 11914.91, "90th_percentile": 14587.72, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10476.26 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 20340.8, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8516.91, "10th_percentile": 8516.91, "90th_percentile": 8516.91, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6643.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5116.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6643.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10476.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6643.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8182.22 } ] } ] }, { "description": "HC X-RAY TMJ UNILAT", "code_information": [ { "code": "70328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 387.81, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 387.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 387.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Levofloxacin in D5W IV Soln 250 MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00143972201", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.2145, "maximum": 2.2145, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.21 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.73, "10th_percentile": 21.73, "90th_percentile": 21.73, "count": "1 through 10" } ] } ] }, { "description": "SPINAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "030", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17743.0, "minimum": 15402.73, "maximum": 39666.9128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39666.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38717.54 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17743.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15402.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17743.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38717.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17743.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24414.31 } ] } ] }, { "description": "HC REPR WND CPLX FACE/HND/FT/GENT 1.1-2.5 CM", "code_information": [ { "code": "13131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1836.25, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 1836.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Aztreonam For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323040201", "type": "NDC" }, { "code": "J0457", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.332, "maximum": 5.332, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.33 } ] } ] }, { "description": "HC (SUP SHELL L8614) COCHLEAR DEVICE", "code_information": [ { "code": "L8614", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23439.0, "minimum": 22778.5741, "maximum": 39641.0008, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28472.05, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22778.57, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25549.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39641.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21629.0, "minimum": 18905.61, "maximum": 89036.5521, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 48900.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 58526.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21629.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18905.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21629.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58526.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21629.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30097.49 } ] } ] }, { "description": "HC WESTERN BLOT TEST", "code_information": [ { "code": "84181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.81, "discounted_cash": 17.0, "minimum": 16.5498, "maximum": 233.5303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE VMA", "code_information": [ { "code": "84585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268.75, "discounted_cash": 15.0, "minimum": 15.0629, "maximum": 234.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)", "code_information": [ { "code": "81276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 989.38, "discounted_cash": 193.0, "minimum": 187.8004, "maximum": 989.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 234.74, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 187.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 989.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 210.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 326.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATH PLC/COR ANGIO RS/IN W RIGHT HEART CATH", "code_information": [ { "code": "93456", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT RADIAL SHAFT FX W MANIP", "code_information": [ { "code": "25505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 715.94, "discounted_cash": 1586.0, "minimum": 214.782, "maximum": 715.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ BREAST LOC DEV PLACE MRI GUIDE ADDL LESION", "code_information": [ { "code": "19288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2553.13, "minimum": 765.939, "maximum": 2226.3294, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "HC RO SET RADN THERAPY FIELD SIMPLE", "code_information": [ { "code": "77280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1289.06, "discounted_cash": 132.0, "minimum": 132.62, "maximum": 1124.0603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 522.47, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 634.68, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 507.76, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOASSAY, TUMOR ANTIGEN, QUANT", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.94, "discounted_cash": 20.0, "minimum": 20.2232, "maximum": 192.6597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 118.9, "10th_percentile": 118.9, "90th_percentile": 118.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 146.74, "10th_percentile": 146.74, "90th_percentile": 146.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ENDOMYOCARDIAL BIOPSY", "code_information": [ { "code": "93505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15604.4, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 14909.8005, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12273.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14909.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBODY DETECTION NOS IF", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.81, "discounted_cash": 16.0, "minimum": 15.646, "maximum": 181.2103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.56, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RBC DEGLYCEROLIZED, PER UNIT", "code_information": [ { "code": "P9039", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2745.94, "discounted_cash": 311.0, "minimum": 311.47, "maximum": 2394.4597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1227.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1490.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1192.53, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 339.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 526.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14950.0, "minimum": 12584.36, "maximum": 44827.6325, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33031.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 39208.76, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22345.08, "10th_percentile": 22345.08, "90th_percentile": 22345.08, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28278.3 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12584.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28278.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20330.43 } ] } ] }, { "description": "HC URETERAL REFLUX STUDY", "code_information": [ { "code": "78740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1004.38, "discounted_cash": 394.0, "minimum": 301.314, "maximum": 1004.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1004.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM", "code_information": [ { "code": "173", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23684.0, "minimum": 21238.79, "maximum": 64369.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 53783.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 64369.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23684.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21238.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23684.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 64369.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 23684.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33102.57 } ] } ] }, { "description": "HC MRI CHEST WO/W CONTRAST", "code_information": [ { "code": "71552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.94, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 3328.7239, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3328.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL TUNNELED CV CATH W/O SUBQ PORT OR PUMP", "code_information": [ { "code": "36589", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2921.88, "discounted_cash": 618.0, "minimum": 618.95, "maximum": 2921.88, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2438.42, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2921.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2369.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4180) REVITA, PER SQ CM", "code_information": [ { "code": "Q4180", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 2214.801, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2214.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP", "code_information": [ { "code": "94610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.38, "discounted_cash": 216.0, "minimum": 40.314, "maximum": 134.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Levofloxacin in D5W IV Soln 500 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "25021013282", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.2145, "maximum": 2.2145, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.21 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.73, "10th_percentile": 21.73, "90th_percentile": 21.73, "count": "1 through 10" } ] } ] }, { "description": "Pneumococcal 20-Valent Conjugate Vaccine Sus Pref Syr 0.5 ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00005200001", "type": "NDC" }, { "code": "90677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 304.0762, "maximum": 672.735, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1158.7, "10th_percentile": 1158.7, "90th_percentile": 1158.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 380.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 304.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 672.74 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9988.0, "minimum": 7877.86, "maximum": 39936.3127, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21241.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 33982.5, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 30154.34, "10th_percentile": 30154.34, "90th_percentile": 30154.34, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32184.74 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9988.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7877.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9988.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32184.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9988.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13073.53 } ] } ] }, { "description": "HC HOME SLEEP TEST/TYPE 3 PORTA - 95806 - 74000034", "code_information": [ { "code": "95806", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1323.44, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1154.0397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 677.54, "10th_percentile": 677.54, "90th_percentile": 806.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 677.54, "10th_percentile": 296.02, "90th_percentile": 798.53, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 923.23, "10th_percentile": 923.23, "90th_percentile": 923.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ, THERAP/PROPH/DIAGN, IV PUSH EA ADD NEW DX", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 412.5, "discounted_cash": 46.0, "minimum": 46.2, "maximum": 359.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 264.0, "10th_percentile": 221.76, "90th_percentile": 887.04, "count": "19" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 487.66, "10th_percentile": 487.66, "90th_percentile": 487.66, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 221.76, "10th_percentile": 138.38, "90th_percentile": 518.1, "count": "32" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 575.52, "10th_percentile": 287.76, "90th_percentile": 580.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L4361) PNEUMA/VAC WALK BOOT PRE OTS", "code_information": [ { "code": "L4361", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 424.0, "minimum": 412.2764, "maximum": 717.4747, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 515.32, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 412.28, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 462.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 717.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L2270) VARUS/VALGUS STRAP PADDED/LI", "code_information": [ { "code": "L2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 72.0, "minimum": 70.1348, "maximum": 122.0539, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.66, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 70.13, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERCUT AORTIC VALVULOPLASTY", "code_information": [ { "code": "92986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22195.3, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 22195.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22124.32, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22195.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6234) HYDROCOLLD DRG <=16 W/O BDR - A6234 - RU272050", "code_information": [ { "code": "A6234", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 9.0669, "maximum": 15.7789, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY", "code_information": [ { "code": "35206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18439.7, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 16079.4184, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12273.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14909.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BFB TRAING W/EMG&/MANOMETRY EA ADDL 15 MIN CNTCT", "code_information": [ { "code": "90913", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.38, "discounted_cash": 20.0, "minimum": 19.8247, "maximum": 95.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26170.0, "minimum": 18780.34, "maximum": 71440.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 59690.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 71440.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 26170.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18780.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26170.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71440.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 26170.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36738.25 } ] } ] }, { "description": "HC ASSAY OF URIC ACID, BLOOD, OTHER SOURCE", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.69, "discounted_cash": 5.0, "minimum": 4.9367, "maximum": 134.8897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.17, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.94, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LACOSAMIDE IVPB 200 MG/100 ML (NS)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "09999401301", "type": "NDC" }, { "code": "C9254", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Cyclosporine Modified Oral Soln 100 MG/ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00172731320", "type": "NDC" }, { "code": "J7502", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.343, "maximum": 4.343, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.34 } ] } ] }, { "description": "Lorazepam Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "65219036801", "type": "NDC" }, { "code": "J2060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.3755, "maximum": 3.3755, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.38 } ] } ] }, { "description": "HC IRRIGATION OF BLADDER", "code_information": [ { "code": "51700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1116.56, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1116.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1116.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC", "code_information": [ { "code": "640", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11205.0, "minimum": 9191.53, "maximum": 30288.4514, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 27266.55, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15515.53, "10th_percentile": 15515.53, "90th_percentile": 23451.65, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24134.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22589.14 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11205.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9191.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11205.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22589.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11205.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14854.12 } ] } ] }, { "description": "HC REPR WND SMP BODY/SCALP/EXTR >30.1 CM", "code_information": [ { "code": "12007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 197.0, "minimum": 197.97, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ketorolac Tromethamine Inj 30 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00338007225", "type": "NDC" }, { "code": "J1885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.3434, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 14.27, "count": "39" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.34, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.27, "10th_percentile": 14.13, "90th_percentile": 14.84, "count": "15" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICROSLIDE CONSULT W SLIDE PREP", "code_information": [ { "code": "88323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1474.38, "discounted_cash": 51.0, "minimum": 51.42, "maximum": 1285.6594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.08, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 192.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylene Blue IV Soln 50 MG/10ML (5 MG/ML)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00143909401", "type": "NDC" }, { "code": "Q9968", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 10.287, "maximum": 49.2305, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.53, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.23, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT GUIDANCE STEREOTACTIC LOCALIZATION", "code_information": [ { "code": "77011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 992.5, "minimum": 297.75, "maximum": 992.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 992.5 } ] } ] }, { "description": "HC UNLISTED CT PROCEDURE", "code_information": [ { "code": "76497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.0, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 335.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 335.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 335.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVASC INTRA LITHOTRIP-ATHER", "code_information": [ { "code": "C9766", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71019.1, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 71019.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TARSAL FX W MANIP EA", "code_information": [ { "code": "28455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 1586.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Digoxin Inj 0.1 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "70515026310", "type": "NDC" }, { "code": "J1160", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.492, "maximum": 10.492, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.49 } ] } ] }, { "description": "HC (SUP SHELL A6216) NON-STERILE GAUZE<=16 SQ IN - A6216 - RU272046", "code_information": [ { "code": "A6216", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EP EVAL TRANSVEN CARDIOVERTER", "code_information": [ { "code": "93642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6438.44, "discounted_cash": 1201.0, "minimum": 1201.34, "maximum": 5749.2528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4732.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5749.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4599.57, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2031.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6236) HYDROCOLLD DRG > 48 IN W/O B", "code_information": [ { "code": "A6236", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 38.0, "minimum": 37.735, "maximum": 65.6693, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.67, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT", "code_information": [ { "code": "61000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1049.06, "discounted_cash": 696.0, "minimum": 314.718, "maximum": 1049.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX EXTREM VENOUS,UNI OR LTD", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1617.19, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1410.1897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 706.1, "10th_percentile": 706.1, "90th_percentile": 706.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 832.19, "10th_percentile": 832.19, "90th_percentile": 832.19, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CCMCC", "code_information": [ { "code": "688", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7058.0, "minimum": 5012.43, "maximum": 17090.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14280.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17090.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7058.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5012.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7058.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17090.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7058.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8789.46 } ] } ] }, { "description": "HC IMMUNOASSAY,INFECT AGENT,QUANT", "code_information": [ { "code": "86317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.25, "discounted_cash": 14.0, "minimum": 14.5673, "maximum": 114.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF MERCURY", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 292.81, "discounted_cash": 16.0, "minimum": 15.8015, "maximum": 255.3303, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 72.68, "10th_percentile": 72.68, "90th_percentile": 72.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 160.6, "10th_percentile": 160.6, "90th_percentile": 160.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 206.14, "10th_percentile": 206.14, "90th_percentile": 206.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC HEART IMAGE, SPECT", "code_information": [ { "code": "78494", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1286.56, "discounted_cash": 394.0, "minimum": 385.968, "maximum": 1286.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1286.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1286.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1286.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1286.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PROSTATECTOMY WITH MCC", "code_information": [ { "code": "665", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24785.0, "minimum": 23765.08, "maximum": 67500.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 56399.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 67500.47 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23765.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67500.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34712.99 } ] } ] }, { "description": "HC HEPATITIS B SURFACE AB TEST", "code_information": [ { "code": "86706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.56, "discounted_cash": 10.0, "minimum": 10.4371, "maximum": 119.0803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 82.4, "10th_percentile": 69.22, "90th_percentile": 82.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 65.61, "10th_percentile": 65.61, "90th_percentile": 65.61, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 73.49, "10th_percentile": 70.62, "90th_percentile": 73.49, "count": "20" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 48.01, "10th_percentile": 48.01, "90th_percentile": 48.01, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 90.64, "10th_percentile": 56.35, "90th_percentile": 95.27, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SEPTIC ARTHRITIS WITHOUT CCMCC", "code_information": [ { "code": "550", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7695.0, "minimum": 5966.88, "maximum": 25155.5694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15794.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11933.63 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7695.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5966.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7695.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11933.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7695.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9721.46 } ] } ] }, { "description": "Perphenazine Tab 4 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904660061", "type": "NDC" }, { "code": "Q0175", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.2624, "maximum": 1.2624, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.26 } ] } ] }, { "description": "HC IMMUNE COMPLEX ASSAY", "code_information": [ { "code": "86332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.19, "discounted_cash": 24.0, "minimum": 23.6828, "maximum": 302.7497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.68, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPLACE CV CATH CMPLT NONTUNNLD W SUBQ PORT/PUMP", "code_information": [ { "code": "36582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8962.19, "discounted_cash": 3115.0, "minimum": 2688.657, "maximum": 8962.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8962.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8962.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8962.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [ { "code": "320", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19341.0, "minimum": 16021.49, "maximum": 52018.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 43463.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 52018.91 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19341.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16021.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19341.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52018.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19341.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26750.98 } ] } ] }, { "description": "HC PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER", "code_information": [ { "code": "93279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.44, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 181.7597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTRA-ARTERIAL PARTICULATE ADMIN", "code_information": [ { "code": "79445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 910.94, "discounted_cash": 230.0, "minimum": 230.23, "maximum": 910.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 907.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 910.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 881.48, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 769.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 389.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LIPID PANEL", "code_information": [ { "code": "80061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 247.5, "discounted_cash": 13.0, "minimum": 13.0124, "maximum": 215.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 143.4, "10th_percentile": 125.5, "90th_percentile": 149.4, "count": "257" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 121.03, "10th_percentile": 34.09, "90th_percentile": 165.68, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 127.81, "10th_percentile": 122.89, "90th_percentile": 133.19, "count": "404" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 59.85, "10th_percentile": 59.85, "90th_percentile": 143.4, "count": "126" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 157.74, "10th_percentile": 70.26, "90th_percentile": 165.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THYROID MET IMAGING ADDN LTD", "code_information": [ { "code": "78016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1523.44, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1523.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1523.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1523.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1523.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD TYPING, PATIENT SERUM", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 378.13, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 329.7294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, LUMBAR SPINE", "code_information": [ { "code": "72148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2668.44, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2326.8797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 763.6, "10th_percentile": 670.95, "90th_percentile": 1707.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1628.17, "10th_percentile": 1628.17, "90th_percentile": 1659.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1114.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 491.66, "10th_percentile": 491.66, "90th_percentile": 491.66, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1861.5, "10th_percentile": 1861.5, "90th_percentile": 1861.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Doxycycline Hyclate For Inj 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68382091001", "type": "NDC" }, { "code": "J1271", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC MRI, CHEST", "code_information": [ { "code": "71550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2893.44, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2523.0797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2451.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITHOUT CCMCC", "code_information": [ { "code": "387", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6229.0, "minimum": 4639.37, "maximum": 19254.4105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12310.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 16840.98, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 20377.28, "10th_percentile": 20377.28, "90th_percentile": 20377.28, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12284.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6229.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6229.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12284.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6229.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7577.2 } ] } ] }, { "description": "HC HPV SEP HI-RSK TYP&POOL RSLT", "code_information": [ { "code": "87626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.56, "discounted_cash": 70.0, "minimum": 68.2204, "maximum": 332.7203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.27, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF AMYLASE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.69, "discounted_cash": 6.0, "minimum": 6.2973, "maximum": 134.8897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 78.83, "10th_percentile": 78.83, "90th_percentile": 78.83, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 83.25, "10th_percentile": 83.25, "90th_percentile": 84.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 108.9, "10th_percentile": 107.91, "90th_percentile": 108.9, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICRODISSECTION, MANUAL", "code_information": [ { "code": "88381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.5, "minimum": 212.25, "maximum": 707.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 707.5 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8887.0, "minimum": 7214.79, "maximum": 34523.4167, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18626.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16233.63 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7214.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16233.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 34523.42, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16824.14, "10th_percentile": 16824.14, "90th_percentile": 16824.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11464.23 } ] } ] }, { "description": "HC MRI, CERV SPINE COMBO", "code_information": [ { "code": "72156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3089.38, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2693.9394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1660.85, "10th_percentile": 1660.85, "90th_percentile": 1660.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1921.34, "10th_percentile": 1921.34, "90th_percentile": 1921.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1945.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 855.6, "10th_percentile": 855.6, "90th_percentile": 855.6, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2174.92, "10th_percentile": 2174.92, "90th_percentile": 2174.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LD SYS", "code_information": [ { "code": "33229", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35935.9, "discounted_cash": 19005.0, "minimum": 10780.77, "maximum": 35935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20716.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32142.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13446.0, "minimum": 11515.02, "maximum": 33195.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29457.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33195.93 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11515.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33195.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18130.56 } ] } ] }, { "description": "HC INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE", "code_information": [ { "code": "33271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24787.8, "discounted_cash": 8165.0, "minimum": 7436.34, "maximum": 24787.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24787.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24787.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24787.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC", "code_information": [ { "code": "43763", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1301.88, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1179.8186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4113) GRAFTJACKET XPRESS, INJECTABLE, 1 CC", "code_information": [ { "code": "Q4113", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1977.0325, "maximum": 1977.0325, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1977.03 } ] } ] }, { "description": "HC SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ", "code_information": [ { "code": "61001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1049.06, "discounted_cash": 696.0, "minimum": 314.718, "maximum": 1049.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC", "code_information": [ { "code": "020", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 60893.0, "minimum": 55793.53, "maximum": 192604.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 142187.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 192603.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 60893.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55793.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60893.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 192604.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 60893.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 87514.28 } ] } ] }, { "description": "Dexamethasone Sod Phosphate Preservative Free Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323050600", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "40" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 4.45, "90th_percentile": 14.84, "count": "24" } ] } ] }, { "description": "HC RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY", "code_information": [ { "code": "74221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.69, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1028.6897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 296.63, "10th_percentile": 296.63, "90th_percentile": 296.63, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 598.34, "10th_percentile": 598.34, "90th_percentile": 598.34, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 692.08, "10th_percentile": 692.08, "90th_percentile": 692.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 675.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 712.2, "10th_percentile": 712.2, "90th_percentile": 712.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4108) INTEGRA MATRIX, PER SQUARE CENTIMETER", "code_information": [ { "code": "Q4108", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 108.532, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 108.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC AG DETECT NOS, EIA, MULT STEP", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 369.06, "discounted_cash": 11.0, "minimum": 11.6422, "maximum": 321.8203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 53.55, "10th_percentile": 53.55, "90th_percentile": 53.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC XRAY SPINE, COMPLETE, 2-3 VW", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 714.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 622.6603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 218.76, "10th_percentile": 218.76, "90th_percentile": 218.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 485.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM NUCLEAR DIAGNOSTIC EXAM UNLISTED", "code_information": [ { "code": "78999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1130.63, "discounted_cash": 394.0, "minimum": 339.189, "maximum": 1130.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1130.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1130.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1130.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SACROILIAC JTS <3 VW", "code_information": [ { "code": "72200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 549.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 278.48, "10th_percentile": 278.48, "90th_percentile": 278.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 99.95, "10th_percentile": 99.95, "90th_percentile": 99.95, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRA SPINAL CANAL W CONTRAST - 72159 - 61800010", "code_information": [ { "code": "72159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2284.38, "minimum": 685.314, "maximum": 2284.38, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2284.38 } ] } ] }, { "description": "HC ARTHROGRAM OF WRIST", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1090.63, "discounted_cash": 344.0, "minimum": 327.189, "maximum": 1090.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 950.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTERPRETATION OF FNA SMEAR", "code_information": [ { "code": "88173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.56, "discounted_cash": 51.0, "minimum": 51.42, "maximum": 176.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 141.25, "10th_percentile": 141.25, "90th_percentile": 141.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 96.84, "10th_percentile": 96.84, "90th_percentile": 285.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 28.51, "10th_percentile": 28.51, "90th_percentile": 141.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 124.3, "10th_percentile": 124.3, "90th_percentile": 248.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNIZ ADMIN, INJ, EA AD VAC", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25.31, "minimum": 7.593, "maximum": 22.0703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 48.11, "10th_percentile": 48.11, "90th_percentile": 48.11, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12279.0, "minimum": 10173.66, "maximum": 26685.5397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26685.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17001.28 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12279.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10173.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12279.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17001.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12279.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16424.5 } ] } ] }, { "description": "HC US, HEAD/NECK TISSUES,REAL TIME", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069.38, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 932.4994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 645.6, "10th_percentile": 645.6, "90th_percentile": 645.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 511.64, "10th_percentile": 511.64, "90th_percentile": 1023.28, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 627.36, "10th_percentile": 627.36, "90th_percentile": 652.49, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 737.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 326.62, "10th_percentile": 326.62, "90th_percentile": 645.6, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 710.16, "10th_percentile": 655.83, "90th_percentile": 746.0, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prothrombin Complex Concentrate Human-lans For Inj 1000 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68982026102", "type": "NDC" }, { "code": "J7165", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.715, "maximum": 6.9015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.76, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.83, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7762.0, "minimum": 6106.0, "maximum": 21956.2665, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15952.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 19264.61, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18375.29, "10th_percentile": 18375.29, "90th_percentile": 18375.29, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7762.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6106.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7762.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7762.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9818.22 } ] } ] }, { "description": "HC APPLY FINGER SPLINT STATIC", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 580.0, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 580.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 580.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLD CLOT FACTOR VIII, VW FC, RISTOCETIN COFACTR", "code_information": [ { "code": "85245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.88, "discounted_cash": 22.0, "minimum": 22.2931, "maximum": 341.7194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TCAT INSJ PERM DUAL CHAMBER LDLS PM COMPL SYS", "code_information": [ { "code": "0795T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71516.9, "discounted_cash": 19005.0, "minimum": 19005.55, "maximum": 71516.9, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71516.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71516.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20716.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32142.19, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71516.9, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "Rifampin For Inj 600 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00068059701", "type": "NDC" }, { "code": "J2804", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CT ORBIT/SELLA/POST FOSSA/EAR W/O CONTR", "code_information": [ { "code": "70480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2150.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1875.3494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 399.22, "10th_percentile": 399.22, "90th_percentile": 399.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4619) FACE TENT", "code_information": [ { "code": "A4619", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4975, "maximum": 4.3464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ", "code_information": [ { "code": "75561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2068.13, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2068.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1111.82, "10th_percentile": 1111.82, "90th_percentile": 1111.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2068.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 966.5, "10th_percentile": 966.5, "90th_percentile": 966.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3680.94, "discounted_cash": 872.0, "minimum": 872.7, "maximum": 3680.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1995.15, "10th_percentile": 815.75, "90th_percentile": 2992.72, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3438.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3680.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3341.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "URETHRAL STRICTURE", "code_information": [ { "code": "697", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9245.0, "minimum": 6733.07, "maximum": 23310.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19475.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23310.02 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6733.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23310.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11986.95 } ] } ] }, { "description": "HC ASSAY OF BLOOD PKU", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.25, "discounted_cash": 5.0, "minimum": 5.3449, "maximum": 341.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BUNDLE OF HIS RECORDING", "code_information": [ { "code": "93600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3523.13, "discounted_cash": 7695.0, "minimum": 1056.939, "maximum": 3523.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BRAF GENE", "code_information": [ { "code": "81210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1315.0, "discounted_cash": 175.0, "minimum": 170.4537, "maximum": 1146.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 213.06, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 170.45, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 920.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 296.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25012.0, "minimum": 22114.34, "maximum": 110733.4719, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 56938.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 80460.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25012.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22114.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25012.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 80460.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 110733.47, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 103056.12, "10th_percentile": 103056.12, "90th_percentile": 103056.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25012.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35044.41 } ] } ] }, { "description": "HC REMV EXT CANAL FOREIGN BODY", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 344.69, "discounted_cash": 131.0, "minimum": 103.407, "maximum": 344.69, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 344.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 344.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 344.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF BENZODIAZEPINES - G0480 - 30100410", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 352.81, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 352.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6232) HYDROGEL DSG>16<=48 SQ IN", "code_information": [ { "code": "A6232", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 9.5042, "maximum": 16.5399, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TOXOPLASMA, IGM", "code_information": [ { "code": "86778", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.63, "discounted_cash": 14.0, "minimum": 14.0036, "maximum": 148.7894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 64.41, "10th_percentile": 64.41, "90th_percentile": 64.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Remdesivir for IV Soln 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "61958290102", "type": "NDC" }, { "code": "J0248", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.5402, "maximum": 27.1754, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC T CELL ABSOLUTE COUNT/RATIO", "code_information": [ { "code": "86360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.94, "discounted_cash": 46.0, "minimum": 45.6552, "maximum": 160.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 112.27, "10th_percentile": 112.27, "90th_percentile": 112.27, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Epinephrine HCl-NaCl IV Soln 4 MG/250ML-0.9% (16 MCG/ML)", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "42023031501", "type": "NDC" }, { "code": "J0171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.5695, "maximum": 1.5695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 14.6, "10th_percentile": 14.6, "90th_percentile": 14.6, "count": "1 through 10" } ] } ] }, { "description": "HC OLIGOCLONAL IMMUNOGLOBULIN", "code_information": [ { "code": "83916", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.75, "discounted_cash": 27.0, "minimum": 26.6176, "maximum": 190.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.62, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.86, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN - G0463 - 76100007", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.25, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 221.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 221.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 221.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [ { "code": "811", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11728.0, "minimum": 9737.62, "maximum": 29579.7977, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25375.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23725.01 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11728.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9737.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11728.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23725.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11728.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15618.18 } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CCMCC", "code_information": [ { "code": "060", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8043.0, "minimum": 6176.59, "maximum": 33976.9917, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16620.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 28911.61, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9430.33, "10th_percentile": 9430.33, "90th_percentile": 9430.33, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19645.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8043.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6176.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8043.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19645.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8043.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10229.72 } ] } ] }, { "description": "HC IV INFU, THERAP/PROPH/DIAGN, INIT, EA ADD HR", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.0, "discounted_cash": 46.0, "minimum": 46.2, "maximum": 353.16, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 201.16, "10th_percentile": 201.16, "90th_percentile": 201.16, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 225.5, "10th_percentile": 196.44, "90th_percentile": 892.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.13, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 256.61, "10th_percentile": 172.2, "90th_percentile": 769.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 196.44, "10th_percentile": 196.44, "90th_percentile": 196.44, "count": "32" } ] } ] }, { "description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [ { "code": "176", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7170.0, "minimum": 5637.42, "maximum": 22878.5356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 20595.93, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 19333.37, "10th_percentile": 19333.37, "90th_percentile": 19333.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14546.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 20073.82, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 48454.85, "10th_percentile": 48454.85, "90th_percentile": 48454.85, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12944.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7170.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5637.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7170.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12944.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7170.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8952.95 } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [ { "code": "372", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8813.0, "minimum": 7124.12, "maximum": 21848.6633, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18449.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15222.43 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8813.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7124.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15222.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8813.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11355.24 } ] } ] }, { "description": "HC (SUP SHELL A4364) ADHESIVE, LIQUID OR EQUAL", "code_information": [ { "code": "A4364", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.0718, "maximum": 7.0861, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.09, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.07, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US BREAST UNILAT LIMITED", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 612.19, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 533.8297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 353.4, "10th_percentile": 296.86, "90th_percentile": 353.4, "count": "20" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 296.87, "10th_percentile": 296.87, "90th_percentile": 296.87, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 343.42, "10th_percentile": 343.42, "90th_percentile": 357.13, "count": "44" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.87, "10th_percentile": 132.89, "90th_percentile": 413.74, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 388.74, "10th_percentile": 338.65, "90th_percentile": 408.31, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4419) OST PCH FOR BAR W FLANGE/FLT", "code_information": [ { "code": "A4419", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.3906, "maximum": 4.1604, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.99, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.39, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [ { "code": "196", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15400.0, "minimum": 13040.48, "maximum": 34101.402, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34101.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28632.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15400.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13040.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15400.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28632.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15400.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20988.83 } ] } ] }, { "description": "HC REM PAC CVDFB PLS GEN &REPL PLSE GEN MULTI LEAD", "code_information": [ { "code": "33264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118780.0, "discounted_cash": 30971.0, "minimum": 30971.47, "maximum": 118780.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118780.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118780.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118580.47, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33758.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52378.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NO PT PRSNT TRAIN INITIAL 30", "code_information": [ { "code": "G0541", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.13, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 294.8494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.54, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC FPVT ST PLMT UNI CPLX LES 1ST VSL", "code_information": [ { "code": "37269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55875.3, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 54512.3773, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44874.72, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54512.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1930) AFO PLASTIC/OTH MATERIAL PREFAB", "code_information": [ { "code": "L1930", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 313.0, "minimum": 304.8731, "maximum": 530.5633, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 381.08, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 304.87, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 341.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 530.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ THRMBC/NFS DIAL CIRC TRLUML BALO ANGIOP S&I", "code_information": [ { "code": "36905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44757.5, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 44757.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44757.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44757.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17313.0, "minimum": 14613.7, "maximum": 45569.7381, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38645.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38442.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17313.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14613.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17313.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38442.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17313.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23785.94 } ] } ] }, { "description": "HC STRAPPING SHOULDER", "code_information": [ { "code": "29240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.94, "discounted_cash": 131.0, "minimum": 100.782, "maximum": 335.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 335.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 335.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 335.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAIN FINGER ABSCESS,COMPLICATED", "code_information": [ { "code": "26011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6264.69, "discounted_cash": 1629.0, "minimum": 1629.64, "maximum": 6264.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6264.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6264.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6239.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [ { "code": "674", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18834.0, "minimum": 15977.2, "maximum": 97362.0128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 42258.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43913.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18834.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15977.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18834.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43913.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18834.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26009.16 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "695", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9747.0, "minimum": 7805.88, "maximum": 24736.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20668.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24736.21 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9747.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7805.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9747.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24736.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9747.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12720.98 } ] } ] }, { "description": "HC CLOT INHIB PROTEIN S,TOTAL", "code_information": [ { "code": "85305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.38, "discounted_cash": 11.0, "minimum": 11.2826, "maximum": 60.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4393) URINE PCH W EX WEAR BAR CONV", "code_information": [ { "code": "A4393", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 12.0, "minimum": 12.5168, "maximum": 21.7827, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT CLAVICLE FX WO MANIP", "code_information": [ { "code": "23500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 487.5, "discounted_cash": 243.0, "minimum": 146.25, "maximum": 487.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 487.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 487.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 487.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dornase Alfa Inhal Soln 2.5 MG/2.5ML", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "50242010039", "type": "NDC" }, { "code": "J7639", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 115.2185, "maximum": 115.2185, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.22 } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 100 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00075062300", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.118, "maximum": 1.118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.12 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6447) CONFORM BAND S W >=5/YD", "code_information": [ { "code": "A6447", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.6405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM IDENTIFY SENTINEL NODE", "code_information": [ { "code": "38792", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1466.25, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1466.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1466.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1466.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1466.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4340) INDWELLING CATHETER SPECIAL - A4340 - RU278115", "code_information": [ { "code": "A4340", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 45.0, "minimum": 43.974, "maximum": 76.5268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.97, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITHOUT CCMCC", "code_information": [ { "code": "337", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12722.0, "minimum": 10624.93, "maximum": 44408.4172, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27737.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 38842.09, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 38652.97, "10th_percentile": 38652.97, "90th_percentile": 38652.97, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30029.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12722.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10624.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12722.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30029.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12722.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17071.78 } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "254", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14598.0, "minimum": 12108.17, "maximum": 52983.6278, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32195.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36549.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12108.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36549.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19815.5 } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "757", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11938.0, "minimum": 9795.76, "maximum": 115265.0322, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25874.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26622.21 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11938.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9795.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11938.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26622.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11938.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15925.13 } ] } ] }, { "description": "HC DRESS/DEBRIDE BURN >10% TTL LG", "code_information": [ { "code": "16030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 838.44, "discounted_cash": 401.0, "minimum": 251.532, "maximum": 838.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 838.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 838.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 838.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4461) SURGICL DRESS HOLD NON-REUSE - A4461 - 27100058", "code_information": [ { "code": "A4461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.5675, "maximum": 7.9486, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13593.0, "minimum": 11184.18, "maximum": 29806.2011, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25792.23, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 21480.93, "10th_percentile": 21480.93, "90th_percentile": 21480.93, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29806.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 25138.39, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 23516.5, "10th_percentile": 23516.5, "90th_percentile": 23516.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13593.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11184.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13593.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13593.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18345.21 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITH MCC", "code_information": [ { "code": "689", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9872.0, "minimum": 8100.03, "maximum": 25461.4926, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20966.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20804.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9872.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8100.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20804.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9872.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12904.49 } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITHOUT CCMCC", "code_information": [ { "code": "053", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8495.0, "minimum": 6377.31, "maximum": 17693.9873, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17693.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16660.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8495.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6377.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8495.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16660.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8495.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10890.35 } ] } ] }, { "description": "HC ARC RBC ANTIBODY SCREEN", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.44, "discounted_cash": 51.0, "minimum": 51.2651, "maximum": 208.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 112.06, "10th_percentile": 112.06, "90th_percentile": 133.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 208.44, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 106.22, "10th_percentile": 106.22, "90th_percentile": 106.22, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 112.17, "10th_percentile": 112.17, "90th_percentile": 114.32, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 43.67, "10th_percentile": 43.67, "90th_percentile": 43.67, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 145.41, "10th_percentile": 51.27, "90th_percentile": 146.74, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVE URETER STENT, PERCUT", "code_information": [ { "code": "50384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11694.1, "discounted_cash": 2062.0, "minimum": 2062.58, "maximum": 10197.2552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8125.74, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9870.89, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7897.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6550) NEG PRES WOUND THER DRSG SET", "code_information": [ { "code": "A6550", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 31.0, "minimum": 30.7769, "maximum": 53.5603, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.56, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.47, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6410) STERILE EYE PAD - A6410 - 27200156", "code_information": [ { "code": "A6410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PUNCH BIOPSY SKIN SINGLE LESION", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1149.38, "discounted_cash": 401.0, "minimum": 344.814, "maximum": 1149.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1149.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1149.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1149.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CCMCC", "code_information": [ { "code": "829", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25081.0, "minimum": 21344.0, "maximum": 78333.7103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57100.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47935.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25081.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21344.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25081.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47935.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25081.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35144.51 } ] } ] }, { "description": "HC (SUP SHELL A6258) TRANSPARENT FILM >16<=48 IN", "code_information": [ { "code": "A6258", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 5.9669, "maximum": 10.384, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.97, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI BRAIN CONTRAST", "code_information": [ { "code": "70552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2251.88, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1963.6394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1708.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [ { "code": "291", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10811.0, "minimum": 9030.95, "maximum": 28178.088, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25366.74, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 36066.0, "10th_percentile": 19124.61, "90th_percentile": 44263.63, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23198.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19785.46 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10811.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9030.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10811.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19785.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28178.09, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22181.08, "10th_percentile": 18699.88, "90th_percentile": 24981.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10811.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14278.01 } ] } ] }, { "description": "HC (SUP SHELL A4434) OST PCH URINE W LOCK FLNG/FT", "code_information": [ { "code": "A4434", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 5.2088, "maximum": 9.0648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1810) KO ELASTIC WITH JOINTS", "code_information": [ { "code": "L1810", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 118.0, "minimum": 115.4401, "maximum": 200.8976, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.29, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.44, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 200.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ST EVAL SPEECH SOUND PROD LANGUAG COMPRHNS, 15 MIN", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 903.44, "discounted_cash": 218.0, "minimum": 95.0, "maximum": 787.7997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 265.41, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 212.34, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 554.06, "10th_percentile": 554.06, "90th_percentile": 554.06, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 238.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4623) TRACHEOSTOMY INNER CANNULA", "code_information": [ { "code": "A4623", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 9.0766, "maximum": 15.7958, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 5% - 00264751010 - 25800000", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00264751010", "type": "NDC" }, { "code": "J7070", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.826, "maximum": 7.826, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83 } ] } ] }, { "description": "HC WORK HARDENING EA ADD HR", "code_information": [ { "code": "97546", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 306.25, "minimum": 91.875, "maximum": 267.05, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [ { "code": "029", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26994.0, "minimum": 23232.83, "maximum": 61647.0661, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 61647.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51617.55 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 26994.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23232.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26994.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51617.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 26994.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37942.72 } ] } ] }, { "description": "Phenylephrine HCl Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "23155062031", "type": "NDC" }, { "code": "J2371", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.37, "10th_percentile": 11.99, "90th_percentile": 102.75, "count": "21" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 63.26, "10th_percentile": 51.37, "90th_percentile": 63.26, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY FOOT 3+ VW", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 490.63, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 427.8294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 296.2, "10th_percentile": 248.81, "90th_percentile": 296.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 248.85, "10th_percentile": 234.74, "90th_percentile": 248.85, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 299.36, "10th_percentile": 287.83, "90th_percentile": 299.36, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 102.59, "10th_percentile": 102.59, "90th_percentile": 296.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 325.82, "10th_percentile": 325.82, "90th_percentile": 325.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US EXTREMITY NON VASCULAR REAL TIME COMP", "code_information": [ { "code": "76881", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.75, "discounted_cash": 103.0, "minimum": 96.5576, "maximum": 583.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 403.8, "10th_percentile": 403.8, "90th_percentile": 403.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.88, "10th_percentile": 41.88, "90th_percentile": 41.88, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8420) PROSTHETIC SOCK MULTI PLY BK", "code_information": [ { "code": "L8420", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 25.0, "minimum": 24.7323, "maximum": 43.041, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEEDLE BIOPSY, LYMPH NODE(S)", "code_information": [ { "code": "38505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3141.25, "discounted_cash": 1629.0, "minimum": 942.375, "maximum": 3141.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1972.71, "10th_percentile": 1972.71, "90th_percentile": 1972.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3141.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3141.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3141.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSRT SINGLE TRANSVEN ELECTROD/PM/DEFIB", "code_information": [ { "code": "33216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16404.7, "discounted_cash": 8165.0, "minimum": 4921.41, "maximum": 16404.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16404.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16404.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16404.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MED NUTR THER, GROUP, EA 30 MIN", "code_information": [ { "code": "97804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.25, "discounted_cash": 11.0, "minimum": 11.6033, "maximum": 53.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HSV, DNA, AMP PROBE", "code_information": [ { "code": "87529", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.81, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 290.2103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 232.17, "10th_percentile": 232.17, "90th_percentile": 232.17, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN - G0463 - 76100008", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.06, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 254.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 254.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 254.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8642) HALLUX IMPLANT", "code_information": [ { "code": "L8642", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 347.0, "minimum": 337.788, "maximum": 587.8442, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 422.22, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 337.79, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 378.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 587.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "URETHRAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "671", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14699.0, "minimum": 11930.3, "maximum": 38818.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32435.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38818.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14699.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11930.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38818.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14699.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19963.42 } ] } ] }, { "description": "HC ANGIO PELVIS", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8203.44, "discounted_cash": 5490.0, "minimum": 810.22, "maximum": 8203.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8203.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8203.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8203.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 810.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8203.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITH CCMCC", "code_information": [ { "code": "116", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14799.0, "minimum": 11548.93, "maximum": 40182.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32672.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40182.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14799.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11548.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14799.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40182.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14799.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20109.11 } ] } ] }, { "description": "HC (SUP SHELL A4404) OSTOMY RING EACH", "code_information": [ { "code": "A4404", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 1.9728, "maximum": 3.4331, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.47, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.97, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8350.0, "minimum": 6634.79, "maximum": 26600.203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17350.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13126.01 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8350.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6634.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8350.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13126.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8350.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10679.04 } ] } ] }, { "description": "Hydromorphone HCl Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323085303", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.98, "10th_percentile": 11.99, "90th_percentile": 39.11, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 44.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "HC REVSC EVASC IVT STENT SF 1ST", "code_information": [ { "code": "37258", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55875.3, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 54512.3773, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44874.72, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54512.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY CLAVICLE", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 417.5, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 97.31, "10th_percentile": 97.31, "90th_percentile": 97.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 211.76, "10th_percentile": 211.76, "90th_percentile": 211.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 277.2, "10th_percentile": 277.2, "90th_percentile": 291.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8603) COLLAGEN IMP URINARY 2.5 ML", "code_information": [ { "code": "L8603", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 536.0, "minimum": 520.9723, "maximum": 906.6354, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 651.19, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 520.97, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 584.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [ { "code": "867", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16967.0, "minimum": 14841.41, "maximum": 45511.1842, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37823.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39181.25 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16967.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14841.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16967.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39181.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16967.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23279.9 } ] } ] }, { "description": "HC X-RAY RIBS 2 VW UNILAT", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 533.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 465.1597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 322.0, "10th_percentile": 322.0, "90th_percentile": 322.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 270.56, "10th_percentile": 270.56, "90th_percentile": 270.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT PROX HUMERUS FX W MANIP", "code_information": [ { "code": "23605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.75, "discounted_cash": 1586.0, "minimum": 263.625, "maximum": 878.75, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6219) GAUZE <= 16 SQ IN W/BORDER - A6219 - 27200123", "code_information": [ { "code": "A6219", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.3216, "maximum": 2.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4388) DRAINABLE PCH W EX WEAR BARR", "code_information": [ { "code": "A4388", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.0349, "maximum": 10.5024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.54, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ESCHAROTOMY", "code_information": [ { "code": "16035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 719.69, "discounted_cash": 401.0, "minimum": 215.907, "maximum": 719.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 719.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 719.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 719.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dronabinol Cap 2.5 MG", "drug_information": { "unit": 60.0, "type": "EA" }, "code_information": [ { "code": "67877075360", "type": "NDC" }, { "code": "Q0167", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.8924, "maximum": 3.8924, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.89 } ] } ] }, { "description": "HC REMOVE FB PHARYNX", "code_information": [ { "code": "42809", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.94, "discounted_cash": 440.0, "minimum": 97.782, "maximum": 325.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAINAGE OF EYELID ABSCESS", "code_information": [ { "code": "67700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 518.13, "discounted_cash": 313.0, "minimum": 155.439, "maximum": 518.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 518.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 518.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 518.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 341.37, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 518.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY OPTIC FORAMEN", "code_information": [ { "code": "70190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 868.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 757.2797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COLORECTAL CANCER SCREEN, SIGMOID, BA ENEMA - G0106 - 32000239", "code_information": [ { "code": "G0106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.56, "discounted_cash": 169.0, "minimum": 120.468, "maximum": 401.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 401.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 401.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 401.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 184.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 285.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ganciclovir Sodium IV Soln 500 MG/10ML (50 MG/ML) (Base Eq)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "25021018510", "type": "NDC" }, { "code": "J1570", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.9935, "maximum": 68.9935, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.99 } ] } ] }, { "description": "HC REPAIR LIP,<1/2 VERT HEIGHT", "code_information": [ { "code": "40652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4016.56, "discounted_cash": 532.0, "minimum": 532.15, "maximum": 3502.4403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2096.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2546.71, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2037.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 580.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 899.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECT PERCUT CHOLANGIO W IMG", "code_information": [ { "code": "47531", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1950.63, "discounted_cash": 3532.0, "minimum": 585.189, "maximum": 1950.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLOSTRIDIUM TOXIN A W/OPTIC", "code_information": [ { "code": "87803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.5, "discounted_cash": 16.0, "minimum": 15.5488, "maximum": 83.9552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.44, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.55, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 61.38, "10th_percentile": 61.38, "90th_percentile": 64.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY ORBITS", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 640.1003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "251", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12414.0, "minimum": 10815.27, "maximum": 38763.7267, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27005.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 35485.24 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12414.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10815.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12414.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35485.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12414.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16621.35 } ] } ] }, { "description": "HC SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/<", "code_information": [ { "code": "11300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 441.25, "discounted_cash": 401.0, "minimum": 132.375, "maximum": 441.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC I&D PERIRECTAL ABSCESS", "code_information": [ { "code": "46040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.69, "discounted_cash": 1180.0, "minimum": 157.407, "maximum": 524.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM IMAGING, WHOLE BODY, SINGLE DAY", "code_information": [ { "code": "78802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6793.44, "discounted_cash": 535.0, "minimum": 535.74, "maximum": 5923.8797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2110.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2563.89, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2051.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2149.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOGENETICS DNA PROBE", "code_information": [ { "code": "88271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1231.56, "discounted_cash": 21.0, "minimum": 20.816, "maximum": 1073.9203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.02, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.82, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46145.0, "minimum": 41776.46, "maximum": 118791.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 107148.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 118790.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 46145.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41776.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46145.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 118791.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 46145.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65948.23 } ] } ] }, { "description": "HC BARTONELLA DNA AMP PROBE", "code_information": [ { "code": "87471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1521.56, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 1326.8003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC URINARY BLADDER RESIDUAL STUDY", "code_information": [ { "code": "78730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.81, "minimum": 63.843, "maximum": 212.81, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.81 } ] } ] }, { "description": "HC REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH", "code_information": [ { "code": "27658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10935.9, "discounted_cash": 3228.0, "minimum": 3228.48, "maximum": 10935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ CATH DRN W IMG PERI/RETRO", "code_information": [ { "code": "49406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8025.0, "discounted_cash": 1629.0, "minimum": 1629.64, "maximum": 7798.9681, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6420.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7798.97, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6239.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US GUIDE HEART BIOPSY", "code_information": [ { "code": "76932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 860.31, "minimum": 258.093, "maximum": 750.1903, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.5 } ] } ] }, { "description": "Epoetin Alfa-epbx Inj 20000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00069131101", "type": "NDC" }, { "code": "Q5106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.6286, "maximum": 31.0559, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC HEP C ANTIBODY, HIGH RISK - 86803 - 30200256", "code_information": [ { "code": "86803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.06, "discounted_cash": 14.0, "minimum": 13.8676, "maximum": 230.2603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 159.4, "10th_percentile": 63.79, "90th_percentile": 159.4, "count": "29" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.33, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 126.92, "10th_percentile": 37.89, "90th_percentile": 184.21, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 142.11, "10th_percentile": 136.61, "90th_percentile": 142.11, "count": "55" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 63.79, "10th_percentile": 63.79, "90th_percentile": 63.79, "count": "13" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 175.34, "10th_percentile": 175.34, "90th_percentile": 175.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT DIST FIBULA FX W MANIP", "code_information": [ { "code": "27788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 597.19, "discounted_cash": 243.0, "minimum": 179.157, "maximum": 597.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 597.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 597.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 597.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MYELOGRAPHY LUMBAR INJ, CERVICAL", "code_information": [ { "code": "62302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1503.13, "discounted_cash": 773.0, "minimum": 450.939, "maximum": 1503.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1503.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1503.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1503.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC", "code_information": [ { "code": "84376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.38, "discounted_cash": 5.0, "minimum": 5.3449, "maximum": 34.3394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF QUINIDINE", "code_information": [ { "code": "80194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.75, "discounted_cash": 14.0, "minimum": 14.1883, "maximum": 125.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.73, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VITAL CAPACITY, TOTAL", "code_information": [ { "code": "94150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 305.63, "discounted_cash": 126.0, "minimum": 91.689, "maximum": 305.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 305.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 305.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 305.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT STERN-CLAV DISLOC W MANIP", "code_information": [ { "code": "23525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.94, "discounted_cash": 243.0, "minimum": 90.282, "maximum": 300.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN DORSAL SP COMBO", "code_information": [ { "code": "72130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2169.38, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1891.6994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1266.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 30 MG/0.3ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "71288043280", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.118, "maximum": 1.118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.12 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "HC REPTILASE TEST", "code_information": [ { "code": "85635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.25, "discounted_cash": 9.0, "minimum": 9.5722, "maximum": 131.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI CERV SPINE CONTRAST", "code_information": [ { "code": "72142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2787.5, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2430.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1700.82, "10th_percentile": 1700.82, "90th_percentile": 1700.82, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1749.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIOSCOPY NON-CORONARY VESSEL/GRAFTS THER IVNTJ", "code_information": [ { "code": "35400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2717.81, "minimum": 815.343, "maximum": 2717.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2717.81 } ] } ] }, { "description": "HC HISTOPLASMA", "code_information": [ { "code": "86698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.25, "discounted_cash": 13.0, "minimum": 13.4011, "maximum": 118.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "574", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27449.0, "minimum": 23981.72, "maximum": 75075.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 62727.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 75075.64 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 27449.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23981.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27449.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75075.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 27449.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38607.8 } ] } ] }, { "description": "HC IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH", "code_information": [ { "code": "87563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 594.06, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 518.0203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 156.85, "10th_percentile": 156.85, "90th_percentile": 156.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 414.42, "10th_percentile": 414.42, "90th_percentile": 414.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEUTRALIZATION TEST VIRAL", "code_information": [ { "code": "86382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.69, "discounted_cash": 16.0, "minimum": 16.4331, "maximum": 296.2097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.43, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 177.46, "10th_percentile": 177.46, "90th_percentile": 177.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125", "code_information": [ { "code": "86304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.13, "discounted_cash": 20.0, "minimum": 20.2232, "maximum": 255.6094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 177.0, "10th_percentile": 177.0, "90th_percentile": 177.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 194.7, "10th_percentile": 109.19, "90th_percentile": 204.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CCMCC", "code_information": [ { "code": "437", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7537.0, "minimum": 5434.63, "maximum": 19653.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15418.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19652.97 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5434.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19653.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9490.13 } ] } ] }, { "description": "HC CLSD TREAT C-MC DISLOC W MANIP W ANES EA", "code_information": [ { "code": "26675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2052.81, "discounted_cash": 1586.0, "minimum": 615.843, "maximum": 2052.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC", "code_information": [ { "code": "516", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16852.0, "minimum": 13923.64, "maximum": 91359.7016, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37550.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44644.42 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16852.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13923.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16852.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44644.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16852.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23111.96 } ] } ] }, { "description": "HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 769.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 670.6203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prednisone Tab 2.5 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "64380083506", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A6443) CONFORM BAND N/S W>=3<5/YD", "code_information": [ { "code": "A6443", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine IV Infusion in D5W Inj 4 MG/ML", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00338040903", "type": "NDC" }, { "code": "J2002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC DENTAL SURGERY PROCEDURE", "code_information": [ { "code": "41899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1014.38, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 1014.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 894.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC REMOVE EYELID FB EMBEDDED", "code_information": [ { "code": "67938", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 520.94, "discounted_cash": 313.0, "minimum": 156.282, "maximum": 520.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 520.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 520.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 520.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 341.37, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 520.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Octreotide Acetate Inj 1000 MCG/ML (1 MG/ML)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323037905", "type": "NDC" }, { "code": "J2354", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.2685, "maximum": 1.2685, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.27 } ] } ] }, { "description": "HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS", "code_information": [ { "code": "50437", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2084.69, "discounted_cash": 3478.0, "minimum": 625.407, "maximum": 2084.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SURG PATH,LEVEL V", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 774.06, "discounted_cash": 353.0, "minimum": 232.218, "maximum": 774.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 416.14, "10th_percentile": 416.14, "90th_percentile": 495.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 774.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 774.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 774.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 774.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 619.25, "10th_percentile": 416.14, "90th_percentile": 619.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 385.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 598.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARTERIAL LINE INSERTION", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2350.0, "minimum": 705.0, "maximum": 2049.2, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1390.57, "10th_percentile": 1390.57, "90th_percentile": 1390.57, "count": "1 through 10" } ] } ] }, { "description": "Epoetin Alfa Inj 4000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "59676030400", "type": "NDC" }, { "code": "J0885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.305, "maximum": 28.7788, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.37, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6266) IMPREG GAUZE NO H20/SAL/YARD - A6266 - 27200151", "code_information": [ { "code": "A6266", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.6433, "maximum": 4.6001, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.3, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.64, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ED LEVEL 1", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.69, "discounted_cash": 83.0, "minimum": 83.2, "maximum": 314.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 175.2, "10th_percentile": 175.2, "90th_percentile": 175.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 314.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 314.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 314.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 362.62, "10th_percentile": 362.62, "90th_percentile": 362.62, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 170.25, "10th_percentile": 170.25, "90th_percentile": 192.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 167.89, "10th_percentile": 167.89, "90th_percentile": 192.99, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 197.62, "10th_percentile": 173.45, "90th_percentile": 197.62, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 192.72, "10th_percentile": 192.72, "90th_percentile": 219.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN OF LEG COMBO", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2044.06, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1782.4203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1272.41, "10th_percentile": 1272.41, "90th_percentile": 1272.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1260.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RH IG, FULL-DOSE, IM - 90384 - 39000005", "code_information": [ { "code": "90384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 512.81, "minimum": 153.843, "maximum": 447.1703, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.65 } ] } ] }, { "description": "HC REVSC EVASC TPVT ST ATHRC UNI CPLX LES 1ST VSL", "code_information": [ { "code": "37294", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC", "code_information": [ { "code": "806", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6782.0, "minimum": 5008.27, "maximum": 13624.6594, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 10411.97, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4715.4, "10th_percentile": 4715.4, "90th_percentile": 10683.35, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9392.98 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 11876.77, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6759.57, "10th_percentile": 6759.57, "90th_percentile": 22647.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6782.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5008.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6782.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9392.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 11904.08, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8460.63, "10th_percentile": 5878.57, "90th_percentile": 25584.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6782.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8385.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 10716.4, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13711.84, "10th_percentile": 13095.39, "90th_percentile": 20433.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13624.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 10129.38, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5169.74, "10th_percentile": 4734.64, "90th_percentile": 13731.37, "count": "1 through 10" } ] } ] }, { "description": "HC US, OB >/= 14 WKS, ADD'L FETUS", "code_information": [ { "code": "76810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1101.88, "minimum": 330.564, "maximum": 960.8394, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 362.71 } ] } ] }, { "description": "HC NM BRAIN IMAGING < 4 STATIC VIEWS W VASCULAR FLOW", "code_information": [ { "code": "78601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.19, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1752.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1553.98, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1752.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1553.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR EXTEN LEG TENDON,PRIM,EA", "code_information": [ { "code": "28208", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6319.38, "discounted_cash": 3228.0, "minimum": 1895.814, "maximum": 6319.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6319.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6319.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6319.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CCMCC", "code_information": [ { "code": "195", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 4309.91, "maximum": 13011.4299, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11356.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9728.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5828.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4309.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5828.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9728.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5828.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6989.98 } ] } ] }, { "description": "URINARY STONES WITH MCC", "code_information": [ { "code": "693", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11273.0, "minimum": 10177.12, "maximum": 29077.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24294.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29077.12 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11273.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10177.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11273.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29077.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11273.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14953.1 } ] } ] }, { "description": "HC TRANSCATH STENT, CCA W/EPS", "code_information": [ { "code": "37215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10182.8, "minimum": 3054.84, "maximum": 10182.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 10182.8 } ] } ] }, { "description": "HC (SUP SHELL Q4106) DERMAGRAFT", "code_information": [ { "code": "Q4106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 96.621, "maximum": 96.621, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.62 } ] } ] }, { "description": "HC ASSAY OF TOTAL TESTOSTERONE", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.19, "discounted_cash": 25.0, "minimum": 25.0822, "maximum": 302.7497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 222.2, "10th_percentile": 222.2, "90th_percentile": 222.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 176.93, "10th_percentile": 176.93, "90th_percentile": 176.93, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 190.43, "10th_percentile": 186.84, "90th_percentile": 190.43, "count": "21" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 115.37, "10th_percentile": 115.37, "90th_percentile": 222.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 135.43, "10th_percentile": 135.43, "90th_percentile": 135.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT MED MALLEOLUS FX W MANIP", "code_information": [ { "code": "27762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.38, "discounted_cash": 1586.0, "minimum": 251.814, "maximum": 839.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC URINE BACT CULT ID", "code_information": [ { "code": "87088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.13, "discounted_cash": 8.0, "minimum": 7.8619, "maximum": 159.6894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 110.6, "10th_percentile": 92.9, "90th_percentile": 110.6, "count": "61" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 88.07, "10th_percentile": 88.07, "90th_percentile": 88.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 98.55, "10th_percentile": 94.78, "90th_percentile": 98.55, "count": "89" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 36.16, "10th_percentile": 36.16, "90th_percentile": 110.6, "count": "25" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 42.45, "10th_percentile": 42.45, "90th_percentile": 127.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SURG PATH,GROSS,LEVEL I", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.25, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 136.536, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 84.0, "10th_percentile": 84.0, "90th_percentile": 84.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT HUMER EPICONDYLR FX W MANIP", "code_information": [ { "code": "24565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3256.56, "discounted_cash": 1586.0, "minimum": 976.968, "maximum": 3256.56, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3256.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3256.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3256.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC GASTROESOPHAGEAL REFLUX EXAM", "code_information": [ { "code": "78262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1104.38, "discounted_cash": 394.0, "minimum": 331.314, "maximum": 1104.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1104.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE", "code_information": [ { "code": "61107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3760.31, "minimum": 1128.093, "maximum": 3760.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 3760.31 } ] } ] }, { "description": "HC FETAL BIOPHYS PROF,W/O NST", "code_information": [ { "code": "76819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 780.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 680.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 195.92, "10th_percentile": 195.92, "90th_percentile": 195.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 435.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 195.92, "10th_percentile": 195.92, "90th_percentile": 195.92, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 518.1, "10th_percentile": 451.34, "90th_percentile": 544.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I", "code_information": [ { "code": "37193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11306.6, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 11306.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11306.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11306.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11306.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "832", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6536.0, "minimum": 5173.0, "maximum": 13039.1965, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 7115.91, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9547.62, "10th_percentile": 9547.62, "90th_percentile": 9547.62, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13039.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8707.17 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6536.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5173.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6536.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8707.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 7904.55, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11524.48, "10th_percentile": 11524.48, "90th_percentile": 11524.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6536.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8025.4 } ] } ] }, { "description": "HC CHOLECYSTOSTOMY,PERCUTANEOUS, COMPLETE", "code_information": [ { "code": "47490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6640.31, "discounted_cash": 3532.0, "minimum": 1992.093, "maximum": 6640.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6640.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6640.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6640.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6252) ABSORPT DRG >16 <=48 W/O BDR - A6252 - RU272054", "code_information": [ { "code": "A6252", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.5092, "maximum": 7.8472, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.64, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY THORACIC SPINE+SWIM 3 VW", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 580.94, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 506.5797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 254.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6224) GAUZE > 48 IN NO W/SAL W/O B - A6224 - RU272049", "code_information": [ { "code": "A6224", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 4.9853, "maximum": 8.6759, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L2755) CARBON GRAPHITE LAMINATION", "code_information": [ { "code": "L2755", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 156.0, "minimum": 152.2616, "maximum": 264.9772, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 152.26, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 264.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [ { "code": "792", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19675.0, "minimum": 4315.59, "maximum": 44256.6521, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25874.7, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6551.56, "10th_percentile": 6551.56, "90th_percentile": 6551.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44256.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 25218.77, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4232.92, "10th_percentile": 4232.92, "90th_percentile": 4232.92, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 4315.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19675.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16955.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19675.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4315.59 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28742.34, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 73063.76, "10th_percentile": 73063.76, "90th_percentile": 73063.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19675.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27239.22 } ] } ] }, { "description": "HC (SUP SHELL Q4040) CAST SUP SHRT LEG PED FBRGLS", "code_information": [ { "code": "Q4040", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 26.0, "minimum": 25.4903, "maximum": 44.3602, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.86, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC", "code_information": [ { "code": "485", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25591.0, "minimum": 22281.84, "maximum": 139799.694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58313.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 69791.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25591.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22281.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25591.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69791.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25591.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35890.77 } ] } ] }, { "description": "Zoledronic Acid IV Soln 5 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "72266015201", "type": "NDC" }, { "code": "J3489", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.501, "maximum": 17.501, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.5 } ] } ] }, { "description": "HC LARYNGOSCOPY INDIRECT DIAGNOSTIC", "code_information": [ { "code": "31505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.63, "discounted_cash": 196.0, "minimum": 154.689, "maximum": 515.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 515.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 515.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 515.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI BRAIN", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2178.75, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1899.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1171.3, "10th_percentile": 513.69, "90th_percentile": 1171.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1329.39, "10th_percentile": 1329.39, "90th_percentile": 1355.01, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1161.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 514.09, "10th_percentile": 514.09, "90th_percentile": 1380.46, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1140.23, "10th_percentile": 1140.23, "90th_percentile": 1140.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25786.0, "minimum": 23575.43, "maximum": 58777.5756, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58777.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48741.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23575.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48741.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36176.6 } ] } ] }, { "description": "HC EXPLORE WOUND,CHEST", "code_information": [ { "code": "20101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11248.1, "discounted_cash": 2035.0, "minimum": 2035.84, "maximum": 9808.3432, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8020.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9742.92, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7794.62, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD", "code_information": [ { "code": "93986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 600.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 523.7494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4322) IRRIGATION SYRINGE", "code_information": [ { "code": "A4322", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.2273, "maximum": 7.3567, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6456) ZINC PASTE BAND W >=3<5/YD - A6456 - RU272008", "code_information": [ { "code": "A6456", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.7395, "maximum": 3.0272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.74, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR LIP,>1/2 VERT HEIGHT", "code_information": [ { "code": "40654", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3190.63, "discounted_cash": 1530.0, "minimum": 957.189, "maximum": 3190.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3190.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3190.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3190.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2589.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF C-PEPTIDE", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 411.88, "discounted_cash": 20.0, "minimum": 20.2232, "maximum": 359.1594, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 289.96, "10th_percentile": 289.96, "90th_percentile": 289.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 221.65, "10th_percentile": 221.65, "90th_percentile": 225.91, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BIOFEEDBACK TRAIN ANY METH", "code_information": [ { "code": "90901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.0, "discounted_cash": 16.0, "minimum": 15.5974, "maximum": 130.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ BREAST LOC DEV PLACE MRI GUIDE 1ST LESION", "code_information": [ { "code": "19287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2553.13, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 2553.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2553.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2553.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2553.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hydroxocobalamin (Antidote) For IV Soln 5 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50633031011", "type": "NDC" }, { "code": "J3424", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 5.0922, "maximum": 21.4432, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.37, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.09, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS", "code_information": [ { "code": "33231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118780.0, "discounted_cash": 30971.0, "minimum": 30971.47, "maximum": 118780.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118780.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118780.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118580.47, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33758.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52378.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "253", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20788.0, "minimum": 17670.16, "maximum": 71411.5539, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 46902.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51989.68 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20788.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17670.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20788.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51989.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20788.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28867.43 } ] } ] }, { "description": "HC CLSD TREAT POST HIP ARTHRPLAS DISLOC W ANES", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 465.94, "discounted_cash": 243.0, "minimum": 139.782, "maximum": 465.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 465.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 465.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 465.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEEDLE BIOPSY OF PANCREAS", "code_information": [ { "code": "48102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1909.38, "discounted_cash": 1629.0, "minimum": 572.814, "maximum": 1909.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1909.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1909.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1909.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1909.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FINE NEEDLE ASP WO IMG GUIDANCE", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1638.44, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 1638.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1638.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC", "code_information": [ { "code": "521", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22877.0, "minimum": 20173.6, "maximum": 84096.2019, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 51864.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 62072.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20173.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62072.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31921.45 } ] } ] }, { "description": "HC (SUP SHELL A4618) BREATHING CIRCUITS", "code_information": [ { "code": "A4618", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 12.0, "minimum": 12.3224, "maximum": 21.4444, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC WORK HARDENING INIT 2 HR", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 565.63, "minimum": 95.0, "maximum": 493.2294, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Immune Globulin (Human) IV or Subcutaneous Soln 5 GM/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "44206043605", "type": "NDC" }, { "code": "J1561", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 49.0, "minimum": 47.5793, "maximum": 195.9005, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.1, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 195.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.47, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 47.58, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Methylprednisolone Acetate Inj Susp 40 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00009307301", "type": "NDC" }, { "code": "J1010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRB VENT&VOL", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 741.25, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 741.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 741.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 741.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 741.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prednisone Tab 5 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60687012211", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC NM PULMONARY VENTILATION & PERFUSION IMAGING", "code_information": [ { "code": "78582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1826.56, "discounted_cash": 535.0, "minimum": 535.74, "maximum": 1826.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1826.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1826.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1826.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1826.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTRAVASC US,HEART,1ST VESSEL", "code_information": [ { "code": "92978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5687.5, "minimum": 1706.25, "maximum": 4959.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 3603.6, "10th_percentile": 3603.6, "90th_percentile": 3603.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3967.6, "10th_percentile": 3967.6, "90th_percentile": 3967.6, "count": "1 through 10" } ] } ] }, { "description": "HC ACTINOTHERAPY ULTRAVIOLET LIGHT", "code_information": [ { "code": "96900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201.56, "discounted_cash": 36.0, "minimum": 36.85, "maximum": 176.353, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.35, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.09, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROTEIN TOT REFRACTOMETRY ANY SRC", "code_information": [ { "code": "84160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.38, "discounted_cash": 5.0, "minimum": 5.4518, "maximum": 82.2994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 21.5, "10th_percentile": 21.5, "90th_percentile": 25.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 20.38, "10th_percentile": 20.38, "90th_percentile": 20.38, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 21.94, "10th_percentile": 21.53, "90th_percentile": 21.94, "count": "17" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 25.08, "10th_percentile": 25.08, "90th_percentile": 25.08, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 28.16, "10th_percentile": 27.9, "90th_percentile": 29.44, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES", "code_information": [ { "code": "11976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2328.75, "discounted_cash": 698.0, "minimum": 698.625, "maximum": 2328.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2328.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2328.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2328.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L2820) SOFT INTERFACE BELOW KNEE SE", "code_information": [ { "code": "L2820", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 132.0, "minimum": 128.7927, "maximum": 224.1347, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.98, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 128.79, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "810", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9007.0, "minimum": 6587.72, "maximum": 32735.3422, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18911.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11701.77 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9007.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6587.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9007.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11701.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9007.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11639.95 } ] } ] }, { "description": "Ceftazidime-Avibactam Sodium For IV Soln 2.5 GM (2-0.5 GM)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00456270001", "type": "NDC" }, { "code": "J0714", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 104.0, "minimum": 101.7766, "maximum": 412.6692, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 412.67, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 127.22, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 101.78, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "042", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14187.0, "minimum": 12164.93, "maximum": 33455.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31219.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33455.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14187.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12164.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14187.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33455.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14187.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19214.93 } ] } ] }, { "description": "HC (SUP SHELL A4628) OROPHARYNGEAL SUCTION CATH - A4628 - 27200093", "code_information": [ { "code": "A4628", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 5.1797, "maximum": 9.0141, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [ { "code": "197", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8266.0, "minimum": 6852.12, "maximum": 17901.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17150.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17901.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8266.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6852.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17901.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8266.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10555.59 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8077.0, "minimum": 6111.53, "maximum": 19990.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16701.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19990.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6111.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19990.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10279.77 } ] } ] }, { "description": "HC (SUP SHELL A6257) TRANSPARENT FILM <= 16 SQ IN - A6257 - RU272058", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.1185, "maximum": 3.6868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4257) RELESE, PER SQ CM", "code_information": [ { "code": "Q4257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 1064.121, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1064.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [ { "code": "085", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18326.0, "minimum": 15683.73, "maximum": 41052.8695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 41052.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36901.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18326.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15683.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18326.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36901.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18326.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25267.34 } ] } ] }, { "description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC", "code_information": [ { "code": "970", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21106.0, "minimum": 18364.36, "maximum": 57037.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 47657.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 57037.85 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21106.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18364.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21106.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57037.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21106.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29332.32 } ] } ] }, { "description": "HC PATH CONSULT IN SURG,W ADDN FRZ SEC", "code_information": [ { "code": "88332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.44, "minimum": 43.032, "maximum": 143.44, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.44 } ] } ] }, { "description": "HC ASSAY OF MAGNESIUM", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.5, "discounted_cash": 6.0, "minimum": 6.5111, "maximum": 93.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 68.0, "10th_percentile": 57.12, "90th_percentile": 68.0, "count": "38" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 64.85, "10th_percentile": 54.15, "90th_percentile": 74.12, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 57.18, "10th_percentile": 57.18, "90th_percentile": 58.28, "count": "81" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 29.95, "10th_percentile": 17.15, "90th_percentile": 68.0, "count": "30" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 74.12, "10th_percentile": 35.16, "90th_percentile": 74.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOGRAM SINUS/JUGULAR", "code_information": [ { "code": "75860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2597.5, "discounted_cash": 3115.0, "minimum": 640.6242, "maximum": 2597.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Azithromycin Tab 250 MG", "drug_information": { "unit": 50.0, "type": "EA" }, "code_information": [ { "code": "00904735006", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.1585, "maximum": 54.1585, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.16 } ] } ] }, { "description": "HC CT ANGIO, CHEST, COMBO, INCL IMAGE PROC", "code_information": [ { "code": "71275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2631.25, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2294.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 726.24, "10th_percentile": 363.12, "90th_percentile": 736.3, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1605.48, "10th_percentile": 1543.72, "90th_percentile": 1605.48, "count": "16" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1787.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 725.62, "10th_percentile": 725.62, "90th_percentile": 725.62, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1747.46, "10th_percentile": 1522.28, "90th_percentile": 1835.56, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICROSOMAL ANTIBODY", "code_information": [ { "code": "86376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 327.19, "discounted_cash": 14.0, "minimum": 14.1397, "maximum": 285.3097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 197.6, "10th_percentile": 165.98, "90th_percentile": 197.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 166.73, "10th_percentile": 166.73, "90th_percentile": 166.73, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 169.34, "10th_percentile": 169.34, "90th_percentile": 176.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 65.04, "10th_percentile": 65.04, "90th_percentile": 65.04, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.86, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 217.36, "10th_percentile": 76.35, "90th_percentile": 228.25, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOGRAM INFER VENA CAVA", "code_information": [ { "code": "75825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8263.75, "discounted_cash": 3115.0, "minimum": 541.162, "maximum": 8263.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8263.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8263.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8263.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 541.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC TPVT ATHRC UNI CPLX LES 1ST VSL", "code_information": [ { "code": "37290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22727.0, "minimum": 20156.3, "maximum": 95394.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 51508.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 95394.95 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22727.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20156.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22727.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 95394.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22727.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31702.35 } ] } ] }, { "description": "HC CLSD TREAT MT-PHAL TOE DISLOC WO ANES", "code_information": [ { "code": "28630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.31, "discounted_cash": 243.0, "minimum": 121.593, "maximum": 405.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 405.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 405.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 405.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 405.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBIOTIC SENS,MIC,EACH", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.88, "discounted_cash": 8.0, "minimum": 8.4061, "maximum": 136.7994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 94.8, "10th_percentile": 79.63, "90th_percentile": 94.8, "count": "14" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.51, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 75.48, "10th_percentile": 75.48, "90th_percentile": 75.48, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 81.24, "10th_percentile": 79.72, "90th_percentile": 239.14, "count": "18" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 38.67, "10th_percentile": 38.67, "90th_percentile": 94.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 103.33, "10th_percentile": 103.33, "90th_percentile": 104.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "373", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6580.0, "minimum": 5020.73, "maximum": 18179.1212, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13144.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10248.3 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6580.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5020.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6580.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10248.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6580.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8089.91 } ] } ] }, { "description": "Midazolam HCl Oral/Rectal/Inj 5 MG/ML (Base Equivalent)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641606101", "type": "NDC" }, { "code": "J2250", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 30.26, "10th_percentile": 30.26, "90th_percentile": 30.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [ { "code": "384", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7549.0, "minimum": 6018.79, "maximum": 17694.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15446.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17694.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7549.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6018.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7549.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17694.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7549.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9506.81 } ] } ] }, { "description": "HC XR FLUORO GUIDANCE CV/PICC LINE", "code_information": [ { "code": "77001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 730.0, "minimum": 219.0, "maximum": 710.7578, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 448.6, "10th_percentile": 448.6, "90th_percentile": 448.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 427.68, "10th_percentile": 427.68, "90th_percentile": 427.68, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 710.76 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 312.5, "10th_percentile": 312.5, "90th_percentile": 312.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 429.87, "10th_percentile": 411.18, "90th_percentile": 493.46, "count": "1 through 10" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18506.0, "minimum": 16381.4, "maximum": 81689.6838, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 41481.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 49645.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18506.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16381.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18506.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49645.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18506.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25530.93 } ] } ] }, { "description": "HC CLSD TREAT NASAL SEPTAL FX", "code_information": [ { "code": "21337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2236.88, "discounted_cash": 3271.0, "minimum": 671.064, "maximum": 2236.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5842.0, "minimum": 4406.81, "maximum": 18378.486, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11391.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10298.96 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 18336.33, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 20188.92, "10th_percentile": 20188.92, "90th_percentile": 20188.92, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5842.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4406.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5842.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10299.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5842.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7011.11 } ] } ] }, { "description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "956", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29667.0, "minimum": 26456.09, "maximum": 150749.43, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 29667.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41850.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 67996.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 150749.43 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 29667.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26456.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29667.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 150749.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC OT EXERCISE OTA COMPLEX EA 15 - G0237 - 42000162", "code_information": [ { "code": "G0237", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 136.536, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ciprofloxacin 400 MG/200ML in D5W", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "25021019287", "type": "NDC" }, { "code": "J0744", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.515, "maximum": 4.515, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.52 } ] } ] }, { "description": "HC (SUP SHELL A4456) ADHESIVE REMOVER, WIPES", "code_information": [ { "code": "A4456", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGRPH CATH F-UP STD TCAT OTHR THAN THROMBYLSIS", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 377.81, "discounted_cash": 3115.0, "minimum": 113.343, "maximum": 377.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 377.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "727", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12326.0, "minimum": 10170.2, "maximum": 81076.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26795.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32069.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12326.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10170.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12326.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32069.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12326.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16492.34 } ] } ] }, { "description": "HC (SUP SHELL L3060) FOOT ARCH SUPP LONGITUD/META", "code_information": [ { "code": "L3060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 88.0, "minimum": 85.9557, "maximum": 149.5866, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.44, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.96, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.41, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 149.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO PULMON BILAT NONSELEC", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2587.19, "discounted_cash": 3115.0, "minimum": 728.3266, "maximum": 2587.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 728.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RETICULOCYTE COUNT, AUTO", "code_information": [ { "code": "85045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.44, "discounted_cash": 3.0, "minimum": 3.8775, "maximum": 111.9997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 77.6, "10th_percentile": 77.6, "90th_percentile": 77.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 65.45, "10th_percentile": 65.45, "90th_percentile": 65.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.84, "10th_percentile": 17.84, "90th_percentile": 17.84, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 85.36, "10th_percentile": 3.99, "90th_percentile": 89.6, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTITIS MEDIA AND URI WITH MCC", "code_information": [ { "code": "152", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10039.0, "minimum": 7854.33, "maximum": 21362.1648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21362.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12798.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10039.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7854.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10039.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12798.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10039.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13148.05 } ] } ] }, { "description": "HC MRI ABDOMEN WO CONTRAST", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1936.56, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1688.6803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1167.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12721.0, "minimum": 10596.56, "maximum": 33194.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27735.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33193.98 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12721.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10596.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12721.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33194.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12721.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17070.67 } ] } ] }, { "description": "HC ASSAY OF SELENIUM", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 346.88, "discounted_cash": 25.0, "minimum": 24.8101, "maximum": 302.4794, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.18, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.01, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 190.25, "10th_percentile": 190.25, "90th_percentile": 190.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS WITH CC", "code_information": [ { "code": "593", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10070.0, "minimum": 8462.71, "maximum": 32213.5897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21436.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17811.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10070.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8462.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10070.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17811.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10070.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13193.65 } ] } ] }, { "description": "HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN", "code_information": [ { "code": "36482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21352.5, "discounted_cash": 5490.0, "minimum": 5490.48, "maximum": 21352.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21352.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21352.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21021.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LEGION PNEUMO AG, DFA", "code_information": [ { "code": "87278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 239.06, "discounted_cash": 15.0, "minimum": 15.1601, "maximum": 208.4603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.16, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9541.0, "minimum": 7349.07, "maximum": 28846.1191, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25968.12, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 490.45, "10th_percentile": 490.45, "90th_percentile": 23592.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20180.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 24545.67, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 34307.05, "10th_percentile": 34307.05, "90th_percentile": 34307.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 25309.82, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16032.53, "10th_percentile": 16032.53, "90th_percentile": 16032.53, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22405.98 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 28779.96, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22577.52, "10th_percentile": 22577.52, "90th_percentile": 22577.52, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9541.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7349.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9541.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22406.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28846.12, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 42036.85, "10th_percentile": 30050.83, "90th_percentile": 65338.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9541.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12420.69 } ] } ] }, { "description": "HC CLSD TREAT RAD/ULNA SHAFT FX WO MANIP", "code_information": [ { "code": "25560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MOG-IGG1 ANTB CBA EACH", "code_information": [ { "code": "86362", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2515.0, "discounted_cash": 12.0, "minimum": 11.7102, "maximum": 2193.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 53.86, "10th_percentile": 53.86, "90th_percentile": 53.86, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX HEMODIALYSIS ACCESS", "code_information": [ { "code": "93990", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 884.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 770.9003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM ACUTE GI BLOOD LOSS IMAGING", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1004.38, "discounted_cash": 394.0, "minimum": 301.314, "maximum": 1004.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1004.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "599", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6899.0, "minimum": 5917.05, "maximum": 16638.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13902.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16638.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6899.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5917.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6899.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16638.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6899.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8557.02 } ] } ] }, { "description": "Diphenhydramine HCl Liquid 12.5 MG/5ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "60687083042", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC MRI, CERV SPINE", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2406.88, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2098.7994, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1679.04, "10th_percentile": 738.05, "90th_percentile": 1694.44, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1293.94, "10th_percentile": 488.62, "90th_percentile": 1293.94, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1468.58, "10th_percentile": 1468.58, "90th_percentile": 1496.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1111.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 503.23, "10th_percentile": 503.23, "90th_percentile": 503.23, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6547.0, "minimum": 5018.66, "maximum": 24219.1659, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13066.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 21250.1, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 24611.3, "10th_percentile": 24611.3, "90th_percentile": 24611.3, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18945.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6547.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5018.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6547.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18945.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6547.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8042.09 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16260.0, "minimum": 13648.17, "maximum": 107497.7271, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36143.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44110.57 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16260.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13648.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16260.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44110.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16260.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22245.58 } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6386.0, "minimum": 4833.16, "maximum": 14822.5747, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12683.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 13005.45, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7114.54, "10th_percentile": 7114.54, "90th_percentile": 7114.54, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11321.84 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6386.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4833.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6386.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11321.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6386.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7806.31 } ] } ] }, { "description": "HC REMOVAL FOOT FB DEEP", "code_information": [ { "code": "28192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1949.69, "discounted_cash": 1629.0, "minimum": 584.907, "maximum": 1949.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1949.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1949.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1949.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1949.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6253) ABSORPT DRG > 48 SQ IN W/O B - A6253 - RU272055", "code_information": [ { "code": "A6253", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 8.7754, "maximum": 15.2715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47656.0, "minimum": 41464.3, "maximum": 110739.2075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 110739.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 79404.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 47656.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41464.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47656.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 79404.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 47656.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68158.1 } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [ { "code": "344", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20691.0, "minimum": 18649.52, "maximum": 55857.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 46670.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 55857.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18649.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55857.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28725.08 } ] } ] }, { "description": "HC RUBEOLA", "code_information": [ { "code": "86765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.25, "discounted_cash": 12.0, "minimum": 12.5168, "maximum": 56.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 34.0, "10th_percentile": 34.0, "90th_percentile": 42.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 28.67, "10th_percentile": 28.67, "90th_percentile": 28.67, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 29.14, "10th_percentile": 29.14, "90th_percentile": 30.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 42.5, "10th_percentile": 42.5, "90th_percentile": 42.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 39.24, "10th_percentile": 37.4, "90th_percentile": 67.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ED LEVEL 3", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1074.06, "discounted_cash": 269.0, "minimum": 269.34, "maximum": 1074.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 502.15, "10th_percentile": 502.15, "90th_percentile": 597.8, "count": "47" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1061.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1074.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1031.22, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 875.18, "10th_percentile": 602.32, "90th_percentile": 1545.9, "count": "63" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 655.35, "10th_percentile": 580.91, "90th_percentile": 655.35, "count": "55" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 777.22, "10th_percentile": 582.52, "90th_percentile": 857.2, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 674.51, "10th_percentile": 591.82, "90th_percentile": 674.51, "count": "30" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 293.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 657.58, "10th_percentile": 657.58, "90th_percentile": 657.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 455.51, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MODER SEDATE SAME PHYS/QHP EACH ADDL 15 MIN", "code_information": [ { "code": "99153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 472.81, "minimum": 141.843, "maximum": 412.2903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 278.98, "10th_percentile": 76.98, "90th_percentile": 310.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1400.29, "10th_percentile": 576.98, "90th_percentile": 1442.46, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 289.97, "10th_percentile": 289.97, "90th_percentile": 315.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 352.25, "10th_percentile": 317.02, "90th_percentile": 1979.0, "count": "1 through 10" } ] } ] }, { "description": "HC CT HEART CNTRST EVAL STRUCT/MORPH, CONGEN DISEASE", "code_information": [ { "code": "75573", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1814.06, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1693.6197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1693.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BILA", "code_information": [ { "code": "36252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9039.06, "discounted_cash": 3115.0, "minimum": 2711.718, "maximum": 9039.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BODY FLUID CELL COUNT W DIFF", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.06, "discounted_cash": 5.0, "minimum": 5.4421, "maximum": 138.7003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 96.0, "10th_percentile": 96.0, "90th_percentile": 96.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 81.06, "10th_percentile": 81.06, "90th_percentile": 81.06, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 85.6, "10th_percentile": 85.6, "90th_percentile": 85.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 110.96, "10th_percentile": 110.96, "90th_percentile": 110.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT", "code_information": [ { "code": "34701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14699.7, "minimum": 4409.91, "maximum": 14699.7, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14699.7 } ] } ] }, { "description": "HC ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING", "code_information": [ { "code": "43260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7151.56, "discounted_cash": 3804.0, "minimum": 2145.468, "maximum": 7151.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4146.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6433.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI", "code_information": [ { "code": "23350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 944.06, "minimum": 283.218, "maximum": 823.2203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 507.53, "10th_percentile": 507.53, "90th_percentile": 507.53, "count": "1 through 10" } ] } ] }, { "description": "HC CT SCAN,MAXILLOFACIAL AREA,W/O CONTRAST", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1417.19, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1235.7897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 694.68, "10th_percentile": 354.52, "90th_percentile": 694.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 835.73, "10th_percentile": 567.7, "90th_percentile": 864.71, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 801.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 988.63, "10th_percentile": 988.63, "90th_percentile": 988.63, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 909.7, "10th_percentile": 840.0, "90th_percentile": 988.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine Inj 2% w/ Epinephrine-1:200000 (PF)", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409318311", "type": "NDC" }, { "code": "J2004", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.84, "90th_percentile": 14.84, "count": "1 through 10" } ] } ] }, { "description": "HC CT SCAN,ABDOMEN,W/O CONTRAST", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2172.19, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1894.1497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MYELOGRAPHY LUMBAR INJ, 2+ REGIONS", "code_information": [ { "code": "62305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1964.38, "discounted_cash": 773.0, "minimum": 589.314, "maximum": 1964.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1964.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1964.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1964.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4450) NON-WATERPROOF TAPE - A4450 - 27090028", "code_information": [ { "code": "A4450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECTION TREATMENT OF NERVE", "code_information": [ { "code": "64620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4217.81, "discounted_cash": 872.0, "minimum": 872.7, "maximum": 4176.4804, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3438.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4176.48, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3341.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PORPHOBILINOGEN URINE QUAN", "code_information": [ { "code": "84110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.81, "discounted_cash": 8.0, "minimum": 8.202, "maximum": 351.2503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Propofol IV Emul 100 MG/10ML (10 MG/ML)", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "25021060820", "type": "NDC" }, { "code": "J2704", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC REVSC EVASC FPVT ST PLMT UNI SF LES 1ST VSL", "code_information": [ { "code": "37267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55875.3, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 54512.3773, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44874.72, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54512.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 59192.0, "minimum": 54099.88, "maximum": 178768.2491, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 138147.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 162973.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 59192.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54099.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 59192.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 162973.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 59192.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 85027.47 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC", "code_information": [ { "code": "690", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7204.0, "minimum": 5555.06, "maximum": 21556.715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 19405.99, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8945.1, "10th_percentile": 8945.1, "90th_percentile": 8945.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14627.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11590.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7204.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5555.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7204.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11590.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7204.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9003.0 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19922.0, "minimum": 17489.51, "maximum": 98648.5098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44843.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 65579.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19922.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17489.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19922.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65579.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19922.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27600.67 } ] } ] }, { "description": "Levalbuterol HCl Soln Nebu 0.31 MG/3ML (Base Equiv)", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "76204070011", "type": "NDC" }, { "code": "J7614", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC HEPATITIS B SURFACE AG, EIA", "code_information": [ { "code": "87340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.56, "discounted_cash": 10.0, "minimum": 10.0387, "maximum": 119.0803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 82.4, "10th_percentile": 46.18, "90th_percentile": 82.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 65.61, "10th_percentile": 65.61, "90th_percentile": 65.61, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 73.49, "10th_percentile": 70.62, "90th_percentile": 73.49, "count": "37" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 46.18, "10th_percentile": 46.18, "90th_percentile": 46.18, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 90.64, "10th_percentile": 90.64, "90th_percentile": 90.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC", "code_information": [ { "code": "278", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43381.0, "minimum": 34629.49, "maximum": 108425.5351, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 100580.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 92261.18, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 89871.41, "10th_percentile": 89871.41, "90th_percentile": 89871.41, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 71747.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 43381.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34629.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43381.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71747.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 43381.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61905.5 } ] } ] }, { "description": "HC OPN ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI", "code_information": [ { "code": "34820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13938.4, "minimum": 4181.52, "maximum": 13938.4, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13938.4 } ] } ] }, { "description": "Acetylcysteine Inhal Soln 10%", "drug_information": { "unit": 4.0, "type": "ML" }, "code_information": [ { "code": "00517750401", "type": "NDC" }, { "code": "J7608", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.146, "maximum": 18.146, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.15 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7459.0, "minimum": 5946.11, "maximum": 18482.2202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15232.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14620.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7459.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5946.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7459.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14620.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 18482.22, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15698.72, "10th_percentile": 15698.72, "90th_percentile": 15698.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7459.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9375.58 } ] } ] }, { "description": "HC (SUP SHELL Q4146) TENSIX, 1CM", "code_information": [ { "code": "Q4146", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVASC LITHOTR-ATHER TIB/PER", "code_information": [ { "code": "C9774", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71019.1, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 71019.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO AORTOGRAM THORACIC", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8860.31, "discounted_cash": 3115.0, "minimum": 1398.2086, "maximum": 8860.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8860.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8860.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8860.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1398.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Magnesium Sulfate IV Soln 4 GM/100ML (40 MG/ML)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338171540", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0535, "maximum": 1.0535, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 72.46, "10th_percentile": 72.46, "90th_percentile": 144.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 80.49, "10th_percentile": 80.49, "90th_percentile": 80.49, "count": "1 through 10" } ] } ] }, { "description": "HC XRAY HIPS W PELVIS, BILAT =>5 VW", "code_information": [ { "code": "73523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 679.69, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 592.6897, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 414.72, "10th_percentile": 398.81, "90th_percentile": 414.72, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 412.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 451.44, "10th_percentile": 451.44, "90th_percentile": 474.15, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INTRA-ATRIAL RECORDING", "code_information": [ { "code": "93602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3523.13, "discounted_cash": 7695.0, "minimum": 1056.939, "maximum": 3523.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYSTO FRAGMENTATION URETERAL STONE", "code_information": [ { "code": "52325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7100.31, "discounted_cash": 5290.0, "minimum": 2130.093, "maximum": 7100.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7100.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7100.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7100.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5766.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7100.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE", "code_information": [ { "code": "33272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8889.06, "discounted_cash": 3687.0, "minimum": 2666.718, "maximum": 8889.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8889.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8889.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8889.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4019.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6235.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55599.0, "minimum": 46226.87, "maximum": 129609.5414, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 129609.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 78832.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 55599.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46226.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55599.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78832.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 55599.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79772.47 } ] } ] }, { "description": "HC (SUP SHELL A4221) SUPP NON-INSULIN INF CATH/WK", "code_information": [ { "code": "A4221", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 25.0, "minimum": 25.1405, "maximum": 43.7513, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.14, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC KETONE BODIES SERUM QUANTITATIVE", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.19, "discounted_cash": 8.0, "minimum": 7.9396, "maximum": 84.7497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 36.52, "10th_percentile": 36.52, "90th_percentile": 36.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 53.31, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 68.42, "10th_percentile": 67.8, "90th_percentile": 68.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PSYCH DIAGNOSTIC EVALUATION", "code_information": [ { "code": "90791", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548.75, "discounted_cash": 175.0, "minimum": 164.625, "maximum": 548.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 548.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 548.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 548.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.89, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 296.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT ULNA SHAFT FX W MANIP", "code_information": [ { "code": "25535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cefepime HCl For IV Soln 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567024110", "type": "NDC" }, { "code": "J0692", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.58, "maximum": 2.58, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.58 } ] } ] }, { "description": "HC ASSAY URINE UREA-N", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.06, "discounted_cash": 5.0, "minimum": 5.4032, "maximum": 73.3003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BILIRUBIN DIRECT", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.19, "discounted_cash": 5.0, "minimum": 4.8784, "maximum": 41.1497, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 24.05, "10th_percentile": 24.05, "90th_percentile": 24.05, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 25.39, "10th_percentile": 25.39, "90th_percentile": 25.88, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 22.44, "10th_percentile": 22.44, "90th_percentile": 22.44, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 32.92, "10th_percentile": 26.25, "90th_percentile": 33.22, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.37, "10th_percentile": 22.44, "90th_percentile": 30.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" } ] } ] }, { "description": "HC PH BODY FLUID NOS", "code_information": [ { "code": "83986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.44, "discounted_cash": 3.0, "minimum": 3.479, "maximum": 68.3997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ELECTRON MICROSCOPY,DIAGNOSTIC", "code_information": [ { "code": "88348", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1577.5, "discounted_cash": 794.0, "minimum": 473.25, "maximum": 1577.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1577.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1577.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1577.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1577.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 866.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1344.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ropivacaine HCl Inj 2 MG/ML", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "25021067187", "type": "NDC" }, { "code": "J2795", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.84, "10th_percentile": 11.99, "90th_percentile": 35.84, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 35.84, "10th_percentile": 35.84, "90th_percentile": 37.78, "count": "1 through 10" } ] } ] }, { "description": "HC HEP B CORE AB TEST, TOTAL", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.06, "discounted_cash": 12.0, "minimum": 11.7102, "maximum": 125.6203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 87.0, "10th_percentile": 53.86, "90th_percentile": 87.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 73.41, "10th_percentile": 73.41, "90th_percentile": 146.82, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 77.53, "10th_percentile": 74.56, "90th_percentile": 77.53, "count": "23" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 53.86, "10th_percentile": 53.86, "90th_percentile": 53.86, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 95.7, "10th_percentile": 95.7, "90th_percentile": 95.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHANGE OF BLADDER TUBE,SIMPLE", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1221.88, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1179.8186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERITONEAL LAVAGE W/WO IMAGING GUIDANCE", "code_information": [ { "code": "49084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2567.19, "discounted_cash": 894.0, "minimum": 770.157, "maximum": 2567.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2567.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2567.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2567.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EPSTEIN-BARR ANTIBODY,V CAPSID", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.63, "discounted_cash": 18.0, "minimum": 17.6285, "maximum": 196.7494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 272.4, "10th_percentile": 272.4, "90th_percentile": 272.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.03, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 229.96, "10th_percentile": 229.96, "90th_percentile": 229.96, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 162.17, "10th_percentile": 162.17, "90th_percentile": 162.17, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 190.36, "10th_percentile": 149.82, "90th_percentile": 314.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY ALKALINE PHOSPHATASE", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.13, "discounted_cash": 5.0, "minimum": 5.0339, "maximum": 72.4894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 44.69, "10th_percentile": 44.69, "90th_percentile": 53.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 42.36, "10th_percentile": 42.36, "90th_percentile": 42.36, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 45.59, "10th_percentile": 33.42, "90th_percentile": 45.59, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.15, "10th_percentile": 23.15, "90th_percentile": 53.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 58.52, "10th_percentile": 42.9, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ETHYLENE GLYCOL", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1101.88, "discounted_cash": 14.0, "minimum": 14.4798, "maximum": 960.8394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "903", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9943.0, "minimum": 8437.79, "maximum": 21134.4849, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21134.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17478.62 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9943.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8437.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9943.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17478.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9943.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13007.92 } ] } ] }, { "description": "HC REMOVAL FB GUM", "code_information": [ { "code": "41805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2236.88, "discounted_cash": 1530.0, "minimum": 671.064, "maximum": 2236.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ertapenem Sodium For Inj 1 GM (Base Equivalent)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "43598090111", "type": "NDC" }, { "code": "J1335", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 19.737, "maximum": 19.737, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.74 } ] } ] }, { "description": "HC (SUP SHELL A4326) MALE EXTERNAL CATHETER", "code_information": [ { "code": "A4326", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 14.0, "minimum": 14.3632, "maximum": 24.9959, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.95, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN CNTCT", "code_information": [ { "code": "90912", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.13, "discounted_cash": 36.0, "minimum": 35.2958, "maximum": 164.0494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35.3, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO ADRENAL BILAT SELECT", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1634.06, "discounted_cash": 3115.0, "minimum": 490.218, "maximum": 1634.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 985.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TRANSFERRIN", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.88, "discounted_cash": 12.0, "minimum": 12.4002, "maximum": 193.4794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 113.07, "10th_percentile": 113.07, "90th_percentile": 113.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 119.4, "10th_percentile": 119.4, "90th_percentile": 121.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 66.95, "10th_percentile": 12.76, "90th_percentile": 154.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ECHO HEART,TRANSESOPHAGEAL,COMPLETE", "code_information": [ { "code": "93312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3845.0, "discounted_cash": 539.0, "minimum": 539.15, "maximum": 3352.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2124.04, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2580.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2064.24, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 2358.06, "10th_percentile": 2358.06, "90th_percentile": 2358.06, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 587.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 911.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4217) STERILE WATER/SALINE, 500 ML", "code_information": [ { "code": "A4217", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.6928, "maximum": 6.4266, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.62, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ciprofloxacin 200 MG/100ML in D5W", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "25021011482", "type": "NDC" }, { "code": "J0744", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.515, "maximum": 4.515, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.52 } ] } ] }, { "description": "VIRAL MENINGITIS WITHOUT CCMCC", "code_information": [ { "code": "076", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7323.0, "minimum": 6346.17, "maximum": 14911.232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14911.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9691.07 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7323.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6346.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7323.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9691.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7323.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9177.61 } ] } ] }, { "description": "HYPERTENSIVE ENCEPHALOPATHY WITH MCC", "code_information": [ { "code": "077", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10702.45, "maximum": 10702.45, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10702.45 } ] } ] }, { "description": "HC EXC SKIN BENIG <0.5 CM SCALP/NECK/HND/FT/GENT", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4403.44, "discounted_cash": 1629.0, "minimum": 1321.032, "maximum": 4403.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4403.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4403.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4403.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECT TRIGGER POINT1-2 MUSCLE", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1200.0, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1200.0, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1193.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1200.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1159.6, "additional_payer_notes": "382.87% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6455) SELF-ADHER BAND >=5/YD - A6455 - 27100098", "code_information": [ { "code": "A6455", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.9339, "maximum": 3.3655, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.93, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATH PLC/COR ANGIO RS/I", "code_information": [ { "code": "93454", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LD", "code_information": [ { "code": "33227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32764.1, "discounted_cash": 8165.0, "minimum": 8165.34, "maximum": 32764.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32168.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32764.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31262.64, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US EXTREMITY NON VASCULAR REAL TIME LTD", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 536.56, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 219.91, "10th_percentile": 219.91, "90th_percentile": 261.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 207.48, "10th_percentile": 207.48, "90th_percentile": 220.0, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 457.5, "10th_percentile": 457.5, "90th_percentile": 475.73, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 470.8, "10th_percentile": 470.8, "90th_percentile": 470.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 478.17, "10th_percentile": 160.02, "90th_percentile": 543.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25", "code_information": [ { "code": "87507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 889.06, "discounted_cash": 416.0, "minimum": 266.718, "maximum": 889.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 506.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 405.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 454.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 704.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL", "code_information": [ { "code": "0075T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37173.4, "minimum": 2944.0066, "maximum": 32415.2048, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2944.01 } ] } ] }, { "description": "HC URINALYSIS NONAUTO W/O SCOPE", "code_information": [ { "code": "81002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.75, "discounted_cash": 3.0, "minimum": 3.3819, "maximum": 59.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION", "code_information": [ { "code": "35011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11465.6, "discounted_cash": 5490.0, "minimum": 3439.68, "maximum": 11465.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11465.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11465.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11465.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Clindamycin Phosphate in D5W IV Soln 600 MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00781328991", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.4615, "maximum": 3.4615, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.46 } ] } ] }, { "description": "HC EVAL FNA SMEAR TO DETERMIN ADEQUACY, FIRST EVAL", "code_information": [ { "code": "88172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.0, "discounted_cash": 168.0, "minimum": 48.0, "maximum": 160.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 87.76, "10th_percentile": 87.76, "90th_percentile": 87.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4452) WATERPROOF TAPE - A4452 - 27100056", "code_information": [ { "code": "A4452", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES - G0463 - 76100002", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.63, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 175.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 175.63, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 175.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.63, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PREALBUMIN", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.31, "discounted_cash": 14.0, "minimum": 14.1786, "maximum": 113.6303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 70.06, "10th_percentile": 70.06, "90th_percentile": 83.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 71.47, "10th_percentile": 70.13, "90th_percentile": 71.47, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 65.22, "10th_percentile": 65.22, "90th_percentile": 65.22, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 90.91, "10th_percentile": 90.91, "90th_percentile": 90.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.67, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ ANTEGRADE NEPHROSTOGRAM/URETEROGRM, EXSIT ACCESS", "code_information": [ { "code": "50431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2351.88, "discounted_cash": 688.0, "minimum": 688.02, "maximum": 2351.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2351.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2351.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2351.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 749.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1163.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C9364) PORCINE IMPLANT, PERMACOL", "code_information": [ { "code": "C9364", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 39.5385, "maximum": 39.5385, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.54 } ] } ] }, { "description": "HC IMMUNODIFFUSION", "code_information": [ { "code": "86329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.5, "discounted_cash": 14.0, "minimum": 13.6538, "maximum": 102.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [ { "code": "369", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8654.0, "minimum": 7043.15, "maximum": 24572.3738, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18073.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15921.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8654.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7043.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8654.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15921.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8654.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11123.9 } ] } ] }, { "description": "HC BLOOD VISCOSITY EXAMINATION", "code_information": [ { "code": "85810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.63, "discounted_cash": 11.0, "minimum": 11.3409, "maximum": 157.5094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6229) GAUZE >16<=48 SQ IN WATR/SAL", "code_information": [ { "code": "A6229", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 4.9853, "maximum": 8.6759, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fluconazole in NaCl 0.9% Inj 200 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "25021018482", "type": "NDC" }, { "code": "J1450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.697, "maximum": 7.697, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.7 } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CCMCC", "code_information": [ { "code": "804", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11360.0, "minimum": 7652.22, "maximum": 41213.2488, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24502.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29675.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7652.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29675.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15081.0 } ] } ] }, { "description": "HC (SUP SHELL A4391) URINARY POUCH W EX WEAR BARR", "code_information": [ { "code": "A4391", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 9.786, "maximum": 17.0304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.79, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US EXAM SPINAL CANAL", "code_information": [ { "code": "76800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 796.56, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 796.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 796.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TREAT BURN 1ST DEGREE, INITIAL", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.63, "discounted_cash": 197.0, "minimum": 99.189, "maximum": 330.63, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC", "code_information": [ { "code": "167", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14763.0, "minimum": 12646.65, "maximum": 54188.904, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32587.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36537.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14763.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12646.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14763.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36537.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 54188.9, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 17055.49, "10th_percentile": 17055.49, "90th_percentile": 17055.49, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14763.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20056.84 } ] } ] }, { "description": "HC REMV TRANSVEN PACER ELECTRODE SINGLE LEAD", "code_information": [ { "code": "33234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7560.31, "discounted_cash": 3687.0, "minimum": 2268.093, "maximum": 7560.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4019.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6235.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Vasopressin IV Soln 20 Unit/ML (For IV Infusion)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323093000", "type": "NDC" }, { "code": "J2598", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.053, "maximum": 3.053, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.05 } ] } ] }, { "description": "Penicillin G Benzathin Intramuscular Susp 2400000 un", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "60793070102", "type": "NDC" }, { "code": "J0561", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 31.0, "minimum": 29.1637, "maximum": 123.9595, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 123.96, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.45, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.16, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US,PREGNANT UTERUS,TRANSVAGINAL", "code_information": [ { "code": "76817", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 699.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 609.5803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 354.48, "10th_percentile": 354.48, "90th_percentile": 354.48, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 334.44, "10th_percentile": 334.44, "90th_percentile": 334.44, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 410.08, "10th_percentile": 410.08, "90th_percentile": 426.54, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 503.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 235.79, "10th_percentile": 222.7, "90th_percentile": 422.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 487.66, "10th_percentile": 464.2, "90th_percentile": 487.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Multiple Level Spinal Fusion Except Cervical without MCC", "code_information": [ { "code": "448", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33300.0, "minimum": 28263.25, "maximum": 103549.2065, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 76630.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 90905.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28263.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 90906.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 33300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47164.82 } ] } ] }, { "description": "HC VIRUS, NOT SPECIFIED", "code_information": [ { "code": "86790", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.63, "discounted_cash": 12.0, "minimum": 12.5168, "maximum": 113.9094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 57.57, "10th_percentile": 57.57, "90th_percentile": 57.57, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 67.58, "10th_percentile": 67.58, "90th_percentile": 67.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6233) HYDROGEL DRESSING >48 SQ IN", "code_information": [ { "code": "A6233", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 27.0, "minimum": 26.5593, "maximum": 46.2205, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT HEART W/O CONTRAST QUANT EVAL CORONARY CALCIUM", "code_information": [ { "code": "75571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.25, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 316.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 238.75, "10th_percentile": 238.75, "90th_percentile": 253.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 316.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 316.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 316.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.25 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 192.96, "10th_percentile": 192.96, "90th_percentile": 192.96, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICROSCOPIC EXAM OF URINE", "code_information": [ { "code": "81015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.06, "discounted_cash": 3.0, "minimum": 2.964, "maximum": 38.4203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.7, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27814.0, "minimum": 25253.86, "maximum": 84708.4983, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 63594.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 79122.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 27814.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25253.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27814.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 79122.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 27814.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39141.64 } ] } ] }, { "description": "HC ASSAY OF PHENOTHIAZINE - G0480 - 30100385", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.94, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L2830) SOFT INTERFACE ABOVE KNEE SE", "code_information": [ { "code": "L2830", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 143.0, "minimum": 139.8809, "maximum": 243.4313, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 174.84, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 139.88, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.89, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX SCAN EXTRACRANIAL,LIMITED", "code_information": [ { "code": "93882", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.44, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 822.6797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PHYS THRP EVAL, HIGH COMPLEXITY, 45 MIN", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.94, "discounted_cash": 94.0, "minimum": 91.4172, "maximum": 458.6197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.27, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.42, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS", "code_information": [ { "code": "38222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.56, "discounted_cash": 2866.0, "minimum": 171.468, "maximum": 571.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 344.92, "10th_percentile": 344.92, "90th_percentile": 344.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CERULOPLASMIN", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.44, "discounted_cash": 10.0, "minimum": 10.4371, "maximum": 138.1597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 48.01, "10th_percentile": 48.01, "90th_percentile": 48.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 80.74, "10th_percentile": 80.74, "90th_percentile": 80.74, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 85.26, "10th_percentile": 85.26, "90th_percentile": 85.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.35, "10th_percentile": 10.74, "90th_percentile": 111.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD FACE <2.5 CM", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI UPPER EXTREMITY W/O CONTRAST", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2335.94, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2182.0753, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2182.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine HCl Local Inj 1%", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409427616", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.13, "90th_percentile": 25.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.7, "10th_percentile": 15.7, "90th_percentile": 15.7, "count": "1 through 10" } ] } ] }, { "description": "HC ANTIHUMAN GLOBULIN DIR EA ANTISERUM", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.63, "discounted_cash": 58.0, "minimum": 28.2824, "maximum": 105.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 24.09, "10th_percentile": 24.09, "90th_percentile": 24.09, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY JAW 4+ VW", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 576.0694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0130) FLEX THERMOPLASTIC COLLAR MO", "code_information": [ { "code": "L0130", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 195.0, "minimum": 190.1424, "maximum": 330.9002, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 237.67, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 190.14, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LARYNGOSCOPY FLEX DIAG", "code_information": [ { "code": "31575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 615.31, "discounted_cash": 196.0, "minimum": 184.593, "maximum": 615.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 615.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 615.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 615.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MYELIN BASIC PROTEIN,CSF", "code_information": [ { "code": "83873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.88, "discounted_cash": 17.0, "minimum": 16.715, "maximum": 250.1594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAYS, BONE LENGTH STUDIES", "code_information": [ { "code": "77073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 919.38, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 801.6994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EHRLICHIA, ANTIBODY", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.81, "discounted_cash": 10.0, "minimum": 9.8929, "maximum": 189.9303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 144.76, "10th_percentile": 144.76, "90th_percentile": 394.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [ { "code": "552", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8359.0, "minimum": 6670.78, "maximum": 23208.2405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17370.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14115.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8359.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6670.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8359.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14115.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8359.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10691.27 } ] } ] }, { "description": "HC EX FOR SPEECH DEVICE RX INIT HR", "code_information": [ { "code": "92607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 638.13, "discounted_cash": 117.0, "minimum": 95.0, "maximum": 556.4494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 142.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 198.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CNS DNA/RNA AMP PROBE MULTIPLE SUBTYPES 12-25", "code_information": [ { "code": "87483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 889.06, "discounted_cash": 416.0, "minimum": 266.718, "maximum": 889.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 506.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 405.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 711.25, "10th_percentile": 711.25, "90th_percentile": 711.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 454.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 704.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS", "code_information": [ { "code": "019", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55309.0, "minimum": 53114.4, "maximum": 154297.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 128921.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 154297.37 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 55309.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54867.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55309.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 154297.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 55309.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79348.74 } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC", "code_information": [ { "code": "279", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28476.0, "minimum": 22178.71, "maximum": 72359.9639, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40109.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 65167.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47021.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28476.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22178.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28476.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47021.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28476.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC", "code_information": [ { "code": "543", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8866.0, "minimum": 7342.84, "maximum": 25616.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18575.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25616.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8866.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7342.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25616.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8866.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11433.09 } ] } ] }, { "description": "HC OCCULT BLOOD OTHER SOURCES", "code_information": [ { "code": "82271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.88, "discounted_cash": 5.0, "minimum": 5.17, "maximum": 53.9594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1782) MORCELLATOR", "code_information": [ { "code": "C1782", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1768.16, "10th_percentile": 1768.16, "90th_percentile": 2831.25, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4355) BLADDER IRRIGATION TUBING", "code_information": [ { "code": "A4355", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 10.4954, "maximum": 18.265, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "675", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13531.0, "minimum": 10833.96, "maximum": 41390.2997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29659.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32995.25 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13531.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10833.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13531.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32995.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13531.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18255.13 } ] } ] }, { "description": "Aminophylline Inj 25 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409592116", "type": "NDC" }, { "code": "J0280", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.7575, "maximum": 23.7575, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.76 } ] } ] }, { "description": "HC ASSAY OF PYRUVATE", "code_information": [ { "code": "84210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.19, "discounted_cash": 14.0, "minimum": 14.0717, "maximum": 324.5497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.07, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6452) HIGH COMPRES BAND W>=3<5YD - A6452 - 27100095", "code_information": [ { "code": "A6452", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.1631, "maximum": 14.2061, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT", "code_information": [ { "code": "20604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1364.38, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1364.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1193.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1364.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1159.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY FOR PANCREAS ENDOSCOPY", "code_information": [ { "code": "74329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2509.38, "minimum": 374.4, "maximum": 2188.1794, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 374.4 } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED MINIMAL PROBLEM(S) - G0463 - 76100006", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.5, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN B-2", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 469.38, "discounted_cash": 20.0, "minimum": 19.6692, "maximum": 409.2994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 90.47, "10th_percentile": 90.47, "90th_percentile": 90.47, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.59, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 327.44, "10th_percentile": 327.44, "90th_percentile": 327.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIESINTRALUMINAL DEVICES", "code_information": [ { "code": "321", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21740.0, "minimum": 19703.64, "maximum": 85880.6605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 77312.29, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 79134.07, "10th_percentile": 79134.07, "90th_percentile": 79134.07, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 49164.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56426.07 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21740.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19703.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21740.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56426.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21740.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30259.87 } ] } ] }, { "description": "HC STRAPPING OF ANKLE AND/OR FT", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 342.5, "discounted_cash": 160.0, "minimum": 102.75, "maximum": 342.5, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.15, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 342.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 342.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 342.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC US, RETROPERITNL ABD, LTD", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 591.0503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 560.4, "10th_percentile": 560.4, "90th_percentile": 560.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 470.75, "10th_percentile": 470.75, "90th_percentile": 470.75, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 566.3, "10th_percentile": 544.57, "90th_percentile": 566.3, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 286.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 131.64, "10th_percentile": 131.64, "90th_percentile": 131.64, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 647.46, "10th_percentile": 647.46, "90th_percentile": 647.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TEAEC W/WO PATCH GRAFT ILIAC", "code_information": [ { "code": "35351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12129.4, "minimum": 3638.82, "maximum": 12129.4, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12129.4 } ] } ] }, { "description": "HC (SUP SHELL A4624) TRACHEAL SUCTION TUBE - A4624 - 27200092", "code_information": [ { "code": "A4624", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.1098, "maximum": 5.4118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Nafcillin Sodium For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55150012315", "type": "NDC" }, { "code": "J2290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Argatroban Inj 250 MG/2.5ML (Concentrate For IV Infusion)", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00143967401", "type": "NDC" }, { "code": "J0883", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.0, "maximum": 3.9908, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE", "code_information": [ { "code": "78599", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1130.63, "discounted_cash": 394.0, "minimum": 339.189, "maximum": 1130.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1130.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1130.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1130.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER", "code_information": [ { "code": "88184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.31, "discounted_cash": 353.0, "minimum": 81.093, "maximum": 270.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 252.75, "10th_percentile": 252.75, "90th_percentile": 252.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 170.02, "10th_percentile": 170.02, "90th_percentile": 173.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 222.42, "10th_percentile": 220.4, "90th_percentile": 506.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND SMP BODY/SCALP/EXTR 12.6-20 CM", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 583.44, "discounted_cash": 401.0, "minimum": 175.032, "maximum": 583.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 583.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 583.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 583.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSITU HYBRIDIZE, PER SPCMN, EA ADD SPCMN SINGL PROB STAIN", "code_information": [ { "code": "88364", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "minimum": 120.0, "maximum": 400.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.0 } ] } ] }, { "description": "HC RO SET RADN THERAPY FIELD INTERME", "code_information": [ { "code": "77285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1691.56, "discounted_cash": 369.0, "minimum": 369.45, "maximum": 1691.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1455.49, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1414.51, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 402.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 624.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMV PERM PACER GENERATOR", "code_information": [ { "code": "33233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7560.31, "discounted_cash": 8165.0, "minimum": 2268.093, "maximum": 7560.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD NECK/HND/FT/GENT 7.6-12.5 CM", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 729.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTHER, IV PUSH,EA ADD DRUG", "code_information": [ { "code": "96411", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360.0, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 339.9761, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 279.87, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.99, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IGK@ GENE REARRANGE DETECT ABNORMAL CLONAL POP", "code_information": [ { "code": "81264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 875.0, "discounted_cash": 172.0, "minimum": 167.859, "maximum": 875.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 209.82, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 167.86, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 875.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHROMOSOME ANALY:AMNIOTIC", "code_information": [ { "code": "88269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 922.81, "discounted_cash": 173.0, "minimum": 168.7628, "maximum": 911.2288, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 210.94, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 168.76, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 911.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 189.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 293.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY PELVIS 1/2 VW", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 724.69, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 631.9297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 225.12, "10th_percentile": 225.12, "90th_percentile": 225.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 36.37, "10th_percentile": 36.37, "90th_percentile": 36.37, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 270.76, "10th_percentile": 260.43, "90th_percentile": 270.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 77.51, "10th_percentile": 77.51, "90th_percentile": 77.51, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 309.56, "10th_percentile": 272.14, "90th_percentile": 505.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMV F.B.,EYE,CORNEA,NO SLIT", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 458.75, "discounted_cash": 440.0, "minimum": 137.625, "maximum": 458.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVASC LITH-STEN-ATH TIB/PER", "code_information": [ { "code": "C9775", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71019.1, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 71019.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOMED, DNA, AMP PROBE", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.69, "discounted_cash": 37.0, "minimum": 36.219, "maximum": 213.3697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 124.15, "10th_percentile": 124.15, "90th_percentile": 147.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.27, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 131.68, "10th_percentile": 131.68, "90th_percentile": 131.68, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 166.6, "10th_percentile": 166.6, "90th_percentile": 166.6, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 162.58, "10th_percentile": 162.58, "90th_percentile": 170.69, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14029.0, "minimum": 10912.86, "maximum": 36915.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30843.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36915.32 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14029.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10912.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14029.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36915.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28555.03, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9119.18, "10th_percentile": 9119.18, "90th_percentile": 33657.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14029.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18983.6 } ] } ] }, { "description": "HC (SUP SHELL Q4042) CAST SUP LNG LEG SPLNT FBRGL", "code_information": [ { "code": "Q4042", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 43.0, "minimum": 42.2636, "maximum": 73.5503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.83, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.26, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.55, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "145", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10192.0, "minimum": 8200.39, "maximum": 21725.3686, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21725.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9718.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10192.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8200.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10192.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9718.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10192.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13371.6 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38479.0, "minimum": 34862.05, "maximum": 104989.1394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 88934.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 96844.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 38479.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34862.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38479.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 96844.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 38479.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54737.57 } ] } ] }, { "description": "HC ALPHA-1-ANTITRYPSIN, PHENO", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 362.19, "discounted_cash": 14.0, "minimum": 14.0522, "maximum": 315.8297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 64.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 184.57, "10th_percentile": 184.57, "90th_percentile": 184.57, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 194.91, "10th_percentile": 194.91, "90th_percentile": 194.91, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 252.66, "10th_percentile": 252.66, "90th_percentile": 252.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC", "code_information": [ { "code": "659", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20372.0, "minimum": 17886.79, "maximum": 51123.8377, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 45913.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34577.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17886.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34577.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 51123.84, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 27150.1, "10th_percentile": 27150.1, "90th_percentile": 27150.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28259.08 } ] } ] }, { "description": "HC (SUP SHELL C1874) STENT COATED/COVR W/DELIVERY SYSTEM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1161.59, "10th_percentile": 1161.59, "90th_percentile": 1161.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2656.11, "10th_percentile": 2656.11, "90th_percentile": 22398.63, "count": "1 through 10" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 120 MG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00548560600", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.118, "maximum": 1.118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.12 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC", "code_information": [ { "code": "580", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14190.0, "minimum": 12271.52, "maximum": 43551.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31224.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43551.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14190.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12271.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14190.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43551.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14190.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19218.26 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8673.0, "minimum": 7447.35, "maximum": 19949.895, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18118.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17451.34 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8673.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7447.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8673.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17451.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8673.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11151.71 } ] } ] }, { "description": "HC X-RAY SINUSES <3 VW", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 467.81, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6266) IMPREG GAUZE NO H20/SAL/YARD - A6266 - RU272007", "code_information": [ { "code": "A6266", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.6433, "maximum": 4.6001, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.3, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.64, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5185.0, "minimum": 3787.35, "maximum": 12090.2547, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 10884.0, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6877.12, "10th_percentile": 6877.12, "90th_percentile": 6877.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 9829.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 10574.81, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4377.1, "10th_percentile": 4377.1, "90th_percentile": 4377.1, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8814.32 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5185.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3787.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5185.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8814.32 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5185.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6050.19 } ] } ] }, { "description": "HC (SUP SHELL A6240) HYDROCOLLD DRG FILLER PASTE", "code_information": [ { "code": "A6240", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 17.0, "minimum": 16.9579, "maximum": 29.5114, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.96, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.51, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN - G0463 - 76100010", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.69, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 334.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 334.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 334.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTERY/S&I UNI", "code_information": [ { "code": "36253", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9039.06, "discounted_cash": 5490.0, "minimum": 2711.718, "maximum": 9039.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [ { "code": "292", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7505.0, "minimum": 5960.65, "maximum": 20419.3057, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15341.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12266.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7505.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5960.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7505.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12266.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7505.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9442.31 } ] } ] }, { "description": "HC (SUP SHELL A6257) TRANSPARENT FILM <= 16 SQ IN - A6257 - 27200146", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.1185, "maximum": 3.6868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35627.0, "minimum": 30954.26, "maximum": 82417.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 82158.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 82417.02 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35627.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30954.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35627.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 82417.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 35627.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50566.94 } ] } ] }, { "description": "HC GLUCOSE BLOOD TEST", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.5, "discounted_cash": 3.0, "minimum": 3.1875, "maximum": 32.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.55, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj PF 40 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009003930", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 43.31, "10th_percentile": 43.31, "90th_percentile": 159.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 51.04, "10th_percentile": 51.04, "90th_percentile": 53.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "count": "1 through 10" } ] } ] }, { "description": "HC METABOLIC PANEL,COMPREHENSIVE", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.88, "discounted_cash": 10.0, "minimum": 10.2622, "maximum": 293.7594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 203.4, "10th_percentile": 170.86, "90th_percentile": 203.4, "count": "354" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 12.83, "10th_percentile": 12.83, "90th_percentile": 12.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.26, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 171.67, "10th_percentile": 161.96, "90th_percentile": 235.0, "count": "11" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 174.31, "10th_percentile": 174.31, "90th_percentile": 181.29, "count": "640" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 47.2, "10th_percentile": 47.2, "90th_percentile": 203.4, "count": "197" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 223.74, "10th_percentile": 55.41, "90th_percentile": 235.0, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR", "code_information": [ { "code": "81229", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2755.0, "discounted_cash": 1160.0, "minimum": 826.5, "maximum": 2755.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1409.05, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1127.29, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2755.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1264.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1961.79, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [ { "code": "595", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17176.0, "minimum": 14639.31, "maximum": 38320.7097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38320.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28703.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17176.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14639.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17176.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28703.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17176.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23585.75 } ] } ] }, { "description": "HC PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE", "code_information": [ { "code": "10035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1114.69, "discounted_cash": 698.0, "minimum": 334.407, "maximum": 1114.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 700.02, "10th_percentile": 700.02, "90th_percentile": 700.02, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1114.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1114.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1114.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1114.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ, THERAP/PROPH/DIAGN, IV PUSH INIT DX", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 633.13, "discounted_cash": 209.0, "minimum": 189.939, "maximum": 633.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 340.37, "10th_percentile": 340.37, "90th_percentile": 405.2, "count": "34" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 633.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 633.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 633.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 374.24, "10th_percentile": 374.24, "90th_percentile": 441.67, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 397.6, "10th_percentile": 313.8, "90th_percentile": 401.15, "count": "16" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 441.67, "10th_percentile": 441.67, "90th_percentile": 445.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 354.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL", "code_information": [ { "code": "64612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 983.13, "discounted_cash": 302.0, "minimum": 294.939, "maximum": 983.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 983.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 983.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 983.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM, EA AG", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.5, "discounted_cash": 353.0, "minimum": 33.3197, "maximum": 242.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [ { "code": "327", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19637.0, "minimum": 16805.68, "maximum": 58565.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44166.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 58565.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19637.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16805.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19637.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58565.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19637.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27183.61 } ] } ] }, { "description": "HC SPECIMEN CONCENTRAT, INFECT AGENTS", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.38, "discounted_cash": 6.0, "minimum": 6.4916, "maximum": 91.0194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.49, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 53.99, "10th_percentile": 53.99, "90th_percentile": 53.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 34.94, "10th_percentile": 34.94, "90th_percentile": 34.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT TUNNEL INTRAPERITONEAL CATH W IMG GUIDE", "code_information": [ { "code": "49418", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4036.56, "discounted_cash": 3532.0, "minimum": 1210.968, "maximum": 4036.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4036.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4036.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4036.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4036.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4216) STERILE WATER/SALINE, 10 ML", "code_information": [ { "code": "A4216", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0655, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6283.0, "minimum": 4759.8, "maximum": 12439.2779, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12439.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8874.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6283.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4759.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6283.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8874.72 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6283.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7656.16 } ] } ] }, { "description": "HC COMPLEMENT/FUNCTION ACTIVITY", "code_information": [ { "code": "86161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 12.0, "minimum": 11.6616, "maximum": 222.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Glycopyrrolate Inj 0.4 MG/2ML (0.2 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "70700016622", "type": "NDC" }, { "code": "J1596", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0965, "maximum": 1.0965, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.1 } ] } ] }, { "description": "HC EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT", "code_information": [ { "code": "34708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7389.06, "minimum": 2216.718, "maximum": 7389.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 7389.06 } ] } ] }, { "description": "HC EPHYS EVAL W ABLATION SUPRAVENT ARRHYTHMIA", "code_information": [ { "code": "93653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60116.9, "discounted_cash": 25790.0, "minimum": 18035.07, "maximum": 60116.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60116.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60116.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60116.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28111.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43616.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BAMLANIVIMAB AND ETESEVIMAB INFUSION AND MONITORING", "code_information": [ { "code": "M0245", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 658.44, "discounted_cash": 435.0, "minimum": 197.532, "maximum": 658.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 658.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 658.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 658.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 474.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 658.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "142", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13189.0, "minimum": 10883.1, "maximum": 32334.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28846.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32334.76 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13189.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10883.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13189.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32334.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13189.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17754.65 } ] } ] }, { "description": "HC INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR", "code_information": [ { "code": "93292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.31, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 279.3103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COMMUNITY/WORK REINTEGRATION COMPLX EA 15 MIN", "code_information": [ { "code": "97537", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.44, "discounted_cash": 30.0, "minimum": 29.8148, "maximum": 98.9197, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.81, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.89, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" } ] } ] }, { "description": "HC FLUORSCOPIC GUIDANCE SPINAL INJECTION", "code_information": [ { "code": "77003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.94, "minimum": 198.282, "maximum": 660.94, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 660.94 } ] } ] }, { "description": "KIDNEY TRANSPLANT", "code_information": [ { "code": "652", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25609.0, "minimum": 21258.17, "maximum": 71093.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58356.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 71093.22 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21258.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71093.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35917.47 } ] } ] }, { "description": "HC MED NUTR THER, SUBSQ, INDIV, EA 15 MIN", "code_information": [ { "code": "97803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.63, "discounted_cash": 21.0, "minimum": 20.7771, "maximum": 65.9494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC", "code_information": [ { "code": "808", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17839.0, "minimum": 15851.92, "maximum": 49817.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39896.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 49817.28 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17839.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15851.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17839.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49817.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17839.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24555.56 } ] } ] }, { "description": "REHABILITATION WITH CCMCC", "code_information": [ { "code": "945", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12825.0, "minimum": 10565.41, "maximum": 33490.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27982.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33490.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10565.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33490.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17223.03 } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "423", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32633.0, "minimum": 28151.82, "maximum": 218868.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75044.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 218867.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32633.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28151.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32633.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 218868.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 32633.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46188.34 } ] } ] }, { "description": "HC ASSAY OF PROGESTERONE", "code_information": [ { "code": "84144", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.31, "discounted_cash": 20.0, "minimum": 20.2717, "maximum": 240.0703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 148.01, "10th_percentile": 148.01, "90th_percentile": 148.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.27, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 140.3, "10th_percentile": 140.3, "90th_percentile": 140.3, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 151.0, "10th_percentile": 151.0, "90th_percentile": 151.0, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 192.06, "10th_percentile": 192.06, "90th_percentile": 192.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX LARGE VESSEL(S),COMPLETE", "code_information": [ { "code": "93978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1845.63, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1609.3894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 419.04, "10th_percentile": 419.04, "90th_percentile": 419.04, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methotrexate Sodium Inj PF 100 MG/4ML (25 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00143951901", "type": "NDC" }, { "code": "J9260", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.7854, "maximum": 6.7854, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79 } ] } ] }, { "description": "HC SPECTROPHOTOMETRY", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.75, "discounted_cash": 8.0, "minimum": 7.8716, "maximum": 173.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "345", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12491.0, "minimum": 10303.78, "maximum": 33663.8303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27189.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 29444.27, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18559.86, "10th_percentile": 18559.86, "90th_percentile": 18559.86, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30080.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12491.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10303.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12491.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30080.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12491.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16734.79 } ] } ] }, { "description": "HC CLSD TREAT NOSE FX W STABIL", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 784.69, "discounted_cash": 3271.0, "minimum": 235.407, "maximum": 784.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Caffeine Citrate Inj 60 MG/3ML (10 MG/ML Base Equiv)", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00641616401", "type": "NDC" }, { "code": "J0706", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.1175, "maximum": 3.1175, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.12 } ] } ] }, { "description": "HC REMOVE FULL ARM/LEG CAST", "code_information": [ { "code": "29705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.13, "discounted_cash": 275.0, "minimum": 62.439, "maximum": 208.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL FOOT FB SUBQ", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4403.44, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 3839.7997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3343.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY KNEE 4+ VIEW", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.94, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 550.1797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 320.04, "10th_percentile": 320.04, "90th_percentile": 381.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 480.02, "10th_percentile": 480.02, "90th_percentile": 480.02, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 384.97, "10th_percentile": 384.97, "90th_percentile": 384.97, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 318.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 440.14, "10th_percentile": 440.14, "90th_percentile": 1025.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prednisone Tab 20 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "59651048801", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC URINALYSIS, AUTO, W/SCOPE", "code_information": [ { "code": "81001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.81, "discounted_cash": 3.0, "minimum": 3.0806, "maximum": 63.4903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 46.6, "10th_percentile": 39.14, "90th_percentile": 46.6, "count": "65" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.08, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 37.11, "10th_percentile": 37.11, "90th_percentile": 37.11, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 39.94, "10th_percentile": 39.94, "90th_percentile": 39.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.17, "10th_percentile": 14.17, "90th_percentile": 46.6, "count": "26" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 50.79, "10th_percentile": 16.63, "90th_percentile": 50.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [ { "code": "506", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11309.0, "minimum": 10375.77, "maximum": 29178.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24379.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29178.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11309.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10375.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11309.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29178.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11309.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15005.37 } ] } ] }, { "description": "HC (SUP SHELL A4338) INDWELLING CATHETER LATEX", "code_information": [ { "code": "A4338", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 17.0, "minimum": 16.9871, "maximum": 29.5622, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC C-REACTIVE PROTEIN", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.81, "discounted_cash": 5.0, "minimum": 5.0339, "maximum": 128.8903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 89.2, "10th_percentile": 74.93, "90th_percentile": 89.2, "count": "38" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 71.03, "10th_percentile": 71.03, "90th_percentile": 75.33, "count": "30" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 76.44, "10th_percentile": 76.44, "90th_percentile": 79.55, "count": "89" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.15, "10th_percentile": 23.15, "90th_percentile": 74.93, "count": "30" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 98.12, "10th_percentile": 98.12, "90th_percentile": 103.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36730.0, "minimum": 32903.31, "maximum": 111949.2231, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 84780.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 95342.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36730.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32903.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36730.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 95342.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 36730.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52180.7 } ] } ] }, { "description": "PROSTATECTOMY WITH CC", "code_information": [ { "code": "666", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14352.0, "minimum": 11401.51, "maximum": 37831.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31609.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37831.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14352.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11401.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14352.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37831.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14352.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19455.15 } ] } ] }, { "description": "HC ONCOPROTEIN DCP", "code_information": [ { "code": "83951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.13, "discounted_cash": 64.0, "minimum": 62.5936, "maximum": 298.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.24, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.59, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 298.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5062) DRNBLE OSTOMY POUCH W/O BARR", "code_information": [ { "code": "A5062", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.0903, "maximum": 5.378, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.09, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8690) AUD OSSEO DEV, INT/EXT COMP", "code_information": [ { "code": "L8690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5717.0, "minimum": 5556.1499, "maximum": 9669.2331, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6944.9, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5556.15, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6231.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9669.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX", "code_information": [ { "code": "95115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.44, "discounted_cash": 46.0, "minimum": 17.532, "maximum": 58.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 58.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 58.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 - G0480 - 31080321", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 478.13, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 478.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0172) CERV COL SR FOAM 2PC PRE OTS", "code_information": [ { "code": "L0172", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 145.0, "minimum": 141.7759, "maximum": 246.7292, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.21, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.73, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT ANGIO,HEAD COMBO,INCL IMAGE PROCESS", "code_information": [ { "code": "70496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1910.0, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1766.7286, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 968.69, "10th_percentile": 968.69, "90th_percentile": 968.69, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1165.41, "10th_percentile": 1120.62, "90th_percentile": 1165.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1766.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 726.24, "10th_percentile": 543.27, "90th_percentile": 726.24, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1332.42, "10th_percentile": 585.68, "90th_percentile": 1332.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRACHEOTOMY PLANNED", "code_information": [ { "code": "31600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9559.06, "discounted_cash": 3271.0, "minimum": 2867.718, "maximum": 9559.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9559.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9559.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9559.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3565.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5532.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CCMCC", "code_information": [ { "code": "735", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11281.0, "minimum": 8401.8, "maximum": 29098.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24312.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29098.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11281.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8401.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11281.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29098.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11281.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14964.22 } ] } ] }, { "description": "HC RP LOCLZJ TUM SPECT W/CT 1 AREA 1 DAY IMAGING", "code_information": [ { "code": "78830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7706.56, "discounted_cash": 1277.0, "minimum": 1277.43, "maximum": 6720.1203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 808.95, "10th_percentile": 808.95, "90th_percentile": 2843.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5032.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6113.4, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4890.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3238.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1392.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2160.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL OF LEG ARTERY CLOT", "code_information": [ { "code": "34203", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13275.6, "discounted_cash": 5490.0, "minimum": 3982.68, "maximum": 13275.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13275.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13275.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13275.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27321.0, "minimum": 23802.45, "maximum": 83714.8144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 62424.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51023.3 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 27321.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23802.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27321.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51023.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 27321.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38420.96 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19751.0, "minimum": 16186.22, "maximum": 54457.6128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44437.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41906.98 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19751.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16186.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19751.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41907.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19751.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27350.44 } ] } ] }, { "description": "HC HEP A ANTIBODY TOTAL", "code_information": [ { "code": "86708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.63, "discounted_cash": 12.0, "minimum": 12.0406, "maximum": 161.8694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 55.38, "10th_percentile": 55.38, "90th_percentile": 55.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 89.18, "10th_percentile": 89.18, "90th_percentile": 89.18, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 99.9, "10th_percentile": 95.98, "90th_percentile": 99.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 123.2, "10th_percentile": 64.8, "90th_percentile": 129.49, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Penicillin G Potassium For Inj 20000000 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00049053028", "type": "NDC" }, { "code": "J2540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.677, "maximum": 1.677, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.68 } ] } ] }, { "description": "Fondaparinux Sodium Subcutaneous Inj 5 MG/0.4ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55111067910", "type": "NDC" }, { "code": "J1652", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.849, "maximum": 1.849, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.85 } ] } ] }, { "description": "HC UGT1A1 GENE ANALYSIS COMMON VARIANTS", "code_information": [ { "code": "81350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 825.63, "discounted_cash": 234.0, "minimum": 227.4012, "maximum": 825.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 284.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 227.4, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 825.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 255.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.74, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD", "code_information": [ { "code": "43265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7151.56, "discounted_cash": 5990.0, "minimum": 2145.468, "maximum": 7151.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6529.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1766) INTRO/SHEATH,STRBLE,NON-PEEL", "code_information": [ { "code": "C1766", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2485.9, "10th_percentile": 2485.9, "90th_percentile": 2485.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3062.76, "10th_percentile": 3062.76, "90th_percentile": 3062.76, "count": "1 through 10" } ] } ] }, { "description": "HC REFILLING & MAINTENANCE PORTABLE PUMP", "code_information": [ { "code": "96521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 271.56, "discounted_cash": 209.0, "minimum": 81.468, "maximum": 271.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 271.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 271.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PINWORM EXAM", "code_information": [ { "code": "87172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.88, "discounted_cash": 4.0, "minimum": 4.1496, "maximum": 75.7594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bivalirudin Trifluoroacetate For IV Soln 250 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "83634040041", "type": "NDC" }, { "code": "J0583", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CT SCAN ABDOMEN/PELVIS W CONTRAST", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3459.06, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 3016.3003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1592.47, "10th_percentile": 1592.47, "90th_percentile": 1592.47, "count": "20" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1842.24, "10th_percentile": 1842.24, "90th_percentile": 1915.9, "count": "42" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1986.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 871.83, "10th_percentile": 871.83, "90th_percentile": 1592.47, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2190.46, "10th_percentile": 2190.46, "90th_percentile": 2190.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC IVT ST CPLX 1ST", "code_information": [ { "code": "37260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55875.3, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 54512.3773, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44874.72, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54512.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [ { "code": "673", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33002.0, "minimum": 28997.6, "maximum": 92361.6302, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75922.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 77748.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33002.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28997.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33002.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 77748.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 33002.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46728.85 } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [ { "code": "041", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17770.0, "minimum": 15629.75, "maximum": 53311.9327, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39730.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46495.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17770.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15629.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17770.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46495.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17770.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24453.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTX ADMN PRTL CAVITY PORT/CATH", "code_information": [ { "code": "96446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 888.44, "discounted_cash": 325.0, "minimum": 266.532, "maximum": 888.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 888.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 888.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 888.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 551.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC URINE PREGNANCY TEST", "code_information": [ { "code": "81025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.94, "discounted_cash": 8.0, "minimum": 8.3672, "maximum": 83.6597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.58, "10th_percentile": 51.58, "90th_percentile": 61.4, "count": "27" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 51.63, "10th_percentile": 51.63, "90th_percentile": 52.62, "count": "50" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 38.49, "10th_percentile": 38.49, "90th_percentile": 61.4, "count": "16" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 45.18, "10th_percentile": 45.18, "90th_percentile": 45.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "654", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22337.0, "minimum": 19532.69, "maximum": 79134.4534, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 50582.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 54818.68 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22337.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19532.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22337.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54818.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22337.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31132.92 } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [ { "code": "335", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28206.0, "minimum": 25078.75, "maximum": 88035.8246, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 64525.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 53117.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25078.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53117.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39714.41 } ] } ] }, { "description": "HC ASSAY, THREE CATECHOLAMINES", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.44, "discounted_cash": 25.0, "minimum": 24.5379, "maximum": 273.3197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.54, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 112.87, "10th_percentile": 112.87, "90th_percentile": 112.87, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ NERV BLCK, TRIGEMINAL", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1132.19, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1132.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1132.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1132.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1132.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3935) FO NONTORSION JOINT CF", "code_information": [ { "code": "L3935", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 241.0, "minimum": 234.3496, "maximum": 407.8329, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 292.92, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 234.35, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 407.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOUS CUTDOWN <1 Y/O", "code_information": [ { "code": "36420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1008.75, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 879.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 628.22, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTINUCLEAR ANTIBODIES TITER", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.25, "discounted_cash": 11.0, "minimum": 10.8453, "maximum": 46.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.52, "10th_percentile": 23.52, "90th_percentile": 28.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 23.57, "10th_percentile": 22.3, "90th_percentile": 23.57, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 24.0, "10th_percentile": 24.0, "90th_percentile": 24.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 35.0, "10th_percentile": 35.0, "90th_percentile": 35.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 32.26, "10th_percentile": 30.8, "90th_percentile": 58.56, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PHENOTYPE INFECT AGENT DRUG", "code_information": [ { "code": "87900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1351.56, "discounted_cash": 130.0, "minimum": 126.6741, "maximum": 1178.5603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 126.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 220.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOPATH FLUIDS,SMEAR,INTERP", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.38, "discounted_cash": 36.0, "minimum": 34.314, "maximum": 114.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR LIP,FULL THICK,VERMILION", "code_information": [ { "code": "40650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2236.88, "discounted_cash": 532.0, "minimum": 532.15, "maximum": 2236.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2096.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2037.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 580.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 899.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT INTER/SUBTROCH FX W MANIP", "code_information": [ { "code": "27240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6001.88, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 6001.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6001.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6001.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6001.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ NERV BLCK, INTERCOSTAL, MULT, REGIONL", "code_information": [ { "code": "64421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.5, "discounted_cash": 872.0, "minimum": 30.75, "maximum": 102.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CANNABINOIDS NATURAL ASSAY - G0480 - 30100418", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.69, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4336) URETHRAL INSERT", "code_information": [ { "code": "A4336", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 1.9922, "maximum": 3.467, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.49, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4114) INTEGRA FLOWABLE WOUND MATRIX", "code_information": [ { "code": "Q4114", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3212.8525, "maximum": 3212.8525, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3212.85 } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "425", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12458.0, "minimum": 10698.99, "maximum": 64808.6009, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27110.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32445.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12458.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10698.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12458.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32445.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12458.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16685.86 } ] } ] }, { "description": "HC CLSD TREAT DIST FINGR FX WO MANIP EA", "code_information": [ { "code": "26750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 438.44, "discounted_cash": 243.0, "minimum": 131.532, "maximum": 438.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 438.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 438.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 438.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SPECIAL STAINS,GROUP I", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 444.69, "discounted_cash": 51.0, "minimum": 51.42, "maximum": 444.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 160.0, "10th_percentile": 160.0, "90th_percentile": 320.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.08, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 107.63, "10th_percentile": 107.63, "90th_percentile": 438.78, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 444.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 107.52, "10th_percentile": 107.52, "90th_percentile": 160.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 279.04, "10th_percentile": 140.8, "90th_percentile": 281.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL", "code_information": [ { "code": "77048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1173.75, "minimum": 352.125, "maximum": 1173.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1173.75 } ] } ] }, { "description": "HC COMPATIBILITY TEST, ELECTRONIC", "code_information": [ { "code": "86923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.25, "discounted_cash": 168.0, "minimum": 28.875, "maximum": 96.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.74, "10th_percentile": 51.74, "90th_percentile": 51.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RENAL FAILURE WITHOUT CCMCC", "code_information": [ { "code": "684", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5613.0, "minimum": 4204.02, "maximum": 18589.9217, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 10847.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 16310.95, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5238.73, "10th_percentile": 5238.73, "90th_percentile": 5238.73, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8551.29 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5613.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4204.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5613.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8551.29 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5613.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6676.34 } ] } ] }, { "description": "HC X-RAY ELBOW 3+ VW", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 533.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 465.1597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 95.79, "10th_percentile": 95.79, "90th_percentile": 95.97, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 354.2, "10th_percentile": 327.15, "90th_percentile": 708.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Chlorpromazine HCl Tab 50 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50268016411", "type": "NDC" }, { "code": "Q0161", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Droperidol Inj 2.5 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00143951401", "type": "NDC" }, { "code": "J1790", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.4255, "maximum": 18.4255, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 15.13, "10th_percentile": 12.71, "90th_percentile": 25.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.43 } ] } ] }, { "description": "HC EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS - G0109 - 42998961", "code_information": [ { "code": "G0109", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.69, "discounted_cash": 15.0, "minimum": 14.888, "maximum": 94.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.61, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "845", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7524.0, "minimum": 5791.77, "maximum": 21733.7193, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15388.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18417.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7524.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5791.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7524.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18417.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7524.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9471.22 } ] } ] }, { "description": "HC EXHALED AIR ANALYSIS", "code_information": [ { "code": "94690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 825.0, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 719.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7054.0, "minimum": 5548.14, "maximum": 18710.1349, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14271.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11840.1 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7054.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5548.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7054.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11840.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7054.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8783.9 } ] } ] }, { "description": "HC SEMEN ANALYSIS, SPERM PRESENCE AND MOTILITY", "code_information": [ { "code": "89321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.44, "discounted_cash": 12.0, "minimum": 11.7102, "maximum": 85.8397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 49.9, "10th_percentile": 49.9, "90th_percentile": 49.9, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 50.16, "10th_percentile": 50.16, "90th_percentile": 50.16, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 49.9, "10th_percentile": 49.9, "90th_percentile": 49.9, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 63.23, "10th_percentile": 63.23, "90th_percentile": 68.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD BODY/SCALP/EXTR 7.6-12.5 CM", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OSTEOMYELITIS WITH CC", "code_information": [ { "code": "540", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10906.0, "minimum": 8956.89, "maximum": 23423.9336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23423.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15337.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10906.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8956.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10906.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15337.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10906.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14417.03 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [ { "code": "699", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8767.0, "minimum": 7059.06, "maximum": 23639.5761, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11288.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18340.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19078.21 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 23585.36, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13712.97, "10th_percentile": 13712.97, "90th_percentile": 13712.97, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8767.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7059.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8767.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19078.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8767.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INSERT PM PULSE GEN ONLY (EXISTING LEADS)", "code_information": [ { "code": "33221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35935.9, "discounted_cash": 19005.0, "minimum": 10780.77, "maximum": 35935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20716.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32142.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRA CHEST W CONTRAST, EXCLUDE HEART - C8909 - 61800004", "code_information": [ { "code": "C8909", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.94, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 3270.8197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ropivacaine HCl Inj 5 MG/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323028605", "type": "NDC" }, { "code": "J2795", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.84, "10th_percentile": 11.99, "90th_percentile": 35.84, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 35.84, "10th_percentile": 35.84, "90th_percentile": 37.78, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A5056) 1 PC OST POUCH W FILTER", "code_information": [ { "code": "A5056", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.4722, "maximum": 11.2634, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANOSCOPY W REMOVE FOREIGN BODY", "code_information": [ { "code": "46608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4313.44, "discounted_cash": 917.0, "minimum": 917.59, "maximum": 4313.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3614.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4313.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3513.18, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1000.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1551.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC M.PNEUMON DNA AMP PROBE", "code_information": [ { "code": "87581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.25, "discounted_cash": 35.0, "minimum": 22.875, "maximum": 76.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 46.0, "10th_percentile": 38.64, "90th_percentile": 46.0, "count": "25" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 38.86, "10th_percentile": 38.86, "90th_percentile": 38.86, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 41.03, "10th_percentile": 39.42, "90th_percentile": 41.03, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 57.5, "10th_percentile": 46.0, "90th_percentile": 61.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 57.5, "10th_percentile": 57.5, "90th_percentile": 57.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ADENOSINE 100 MCG/ML IN NS SYRINGE - CATH LAB (SITE)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "09999401370", "type": "NDC" }, { "code": "J0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC OP CARDIAC REHAB WO CONT ECG MONIT PER SESSION", "code_information": [ { "code": "93797", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.63, "discounted_cash": 127.0, "minimum": 40.689, "maximum": 135.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 135.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 135.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0120) CERV FLEX N/ADJ FOAM PRE OTS", "code_information": [ { "code": "L0120", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 30.0, "minimum": 29.6399, "maximum": 51.5816, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.05, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.64, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN HEAD COMBO", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2818.13, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2457.4094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 229.98, "10th_percentile": 229.98, "90th_percentile": 229.98, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1038.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51055.0, "minimum": 44697.26, "maximum": 155998.2014, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 118814.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 154164.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44697.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 154165.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 73128.38 } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "724", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6034.0, "minimum": 4546.62, "maximum": 14180.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11848.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14180.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6034.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4546.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6034.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14180.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6034.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7292.49 } ] } ] }, { "description": "Cefazolin Sodium For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567084001", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7845, "maximum": 1.7845, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.87, "10th_percentile": 11.99, "90th_percentile": 26.05, "count": "1 through 10" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10718.0, "minimum": 8615.67, "maximum": 27499.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22975.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27498.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10718.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8615.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10718.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27499.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10718.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14141.22 } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITHOUT CCMCC", "code_information": [ { "code": "976", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7913.0, "minimum": 6942.09, "maximum": 19522.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16311.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19522.43 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7913.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6942.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7913.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19522.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7913.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10039.54 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42362.0, "minimum": 40691.5, "maximum": 117483.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 98160.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 117483.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 42362.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41776.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42362.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 117483.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 42362.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 60416.3 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [ { "code": "315", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8374.0, "minimum": 6660.4, "maximum": 23231.8131, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 20913.96, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11637.51, "10th_percentile": 11637.51, "90th_percentile": 11637.51, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17406.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16272.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8374.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6660.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8374.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16272.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 23231.81, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 43221.85, "10th_percentile": 43221.85, "90th_percentile": 43221.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8374.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10713.51 } ] } ] }, { "description": "Morphine Sulfate IV Soln 1 MG/ML - 09999612701 - 25000001", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "09999612701", "type": "NDC" }, { "code": "J2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.9545, "maximum": 9.9545, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 47.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 14.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "HC ECHO TTHRC R-T 2D W/WO M-MODE RST&STRS CONT ECG", "code_information": [ { "code": "93351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3015.94, "discounted_cash": 539.0, "minimum": 539.15, "maximum": 2629.8997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1513.51, "10th_percentile": 1513.51, "90th_percentile": 1513.51, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2124.04, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2580.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2064.24, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1840.2, "10th_percentile": 1750.9, "90th_percentile": 1875.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1849.61, "10th_percentile": 1726.57, "90th_percentile": 1849.61, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1894.01, "10th_percentile": 1894.01, "90th_percentile": 1894.01, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 587.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1849.61, "10th_percentile": 1726.57, "90th_percentile": 2123.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 911.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prochlorperazine Maleate Tab 10 MG (Base Equivalent)", "drug_information": { "unit": 50.0, "type": "EA" }, "code_information": [ { "code": "00904738206", "type": "NDC" }, { "code": "Q0164", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A6238) HYDROCOLLD DRG >16<=48 W/BDR", "code_information": [ { "code": "A6238", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 32.0, "minimum": 31.5835, "maximum": 54.964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.58, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Albumin, Human Inj 5%", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "68516521402", "type": "NDC" }, { "code": "P9045", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 53.0, "minimum": 51.5831, "maximum": 209.1021, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 209.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.48, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4168) AMNIOBAND, 1 MG", "code_information": [ { "code": "Q4168", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 36.6575, "maximum": 36.6575, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.66 } ] } ] }, { "description": "HC IRON BINDING TEST", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.06, "discounted_cash": 8.0, "minimum": 8.4935, "maximum": 116.9003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 85.8, "10th_percentile": 72.07, "90th_percentile": 85.8, "count": "35" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 68.32, "10th_percentile": 68.32, "90th_percentile": 82.67, "count": "14" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 73.53, "10th_percentile": 72.15, "90th_percentile": 73.53, "count": "69" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 39.07, "10th_percentile": 39.07, "90th_percentile": 85.8, "count": "14" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 93.52, "10th_percentile": 45.86, "90th_percentile": 94.38, "count": "113" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROSTATE SPECIFIC ANTIGEN,FREE", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.5, "discounted_cash": 18.0, "minimum": 17.8714, "maximum": 350.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 82.2, "10th_percentile": 82.2, "90th_percentile": 82.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 205.11, "10th_percentile": 205.11, "90th_percentile": 205.11, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 82.2, "10th_percentile": 82.2, "90th_percentile": 82.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 280.78, "10th_percentile": 280.78, "90th_percentile": 280.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fosphenytoin Sodium Inj 100 MG/2ML (Phenytoin Equiv)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00641613701", "type": "NDC" }, { "code": "Q2009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.332, "maximum": 5.9985, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MORPH INSITU HYBRIDIZE MANL PER SPCMN EA MULTPLX PROB STAIN", "code_information": [ { "code": "88377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1868.13, "discounted_cash": 168.0, "minimum": 168.1, "maximum": 1868.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 662.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 804.48, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 643.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 726.52, "10th_percentile": 726.52, "90th_percentile": 726.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1868.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IRRIGAT CORPUS CAVERN,PRIAPISM", "code_information": [ { "code": "54220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1350.94, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1179.8186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PAPPA SERUM", "code_information": [ { "code": "84163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.94, "discounted_cash": 15.0, "minimum": 14.6256, "maximum": 218.8197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US,PREGNANT UTERUS,F/U,TRANSABD APP", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 614.271, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 270.26, "10th_percentile": 270.26, "90th_percentile": 270.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 614.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Medroxyprogesterone Acetate IM Susp 150 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00548540000", "type": "NDC" }, { "code": "J1050", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.2255, "maximum": 1.2255, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.23 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [ { "code": "564", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12787.0, "minimum": 10860.95, "maximum": 27892.605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27892.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22805.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10860.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22805.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17167.43 } ] } ] }, { "description": "HC DUPLEX UP EXTREM ART BILAT", "code_information": [ { "code": "93930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1981.88, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1728.1994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PNEUMOTHORAX WITH MCC", "code_information": [ { "code": "199", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14464.0, "minimum": 12218.22, "maximum": 31877.0047, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31877.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21792.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14464.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12218.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14464.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21792.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14464.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19619.76 } ] } ] }, { "description": "HC (SUP SHELL A4556) ELECTRODES, PAIR", "code_information": [ { "code": "A4556", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 14.0, "minimum": 14.2952, "maximum": 24.8776, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN OF ABDOMEN COMBO", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3903.13, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 3403.5294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 725.3, "10th_percentile": 725.3, "90th_percentile": 736.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1787.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2359.21, "10th_percentile": 2225.63, "90th_percentile": 2683.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICROALBUMIN, QUANTITATIVE", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.75, "discounted_cash": 5.0, "minimum": 5.617, "maximum": 138.43, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 106.7, "10th_percentile": 106.7, "90th_percentile": 106.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 97.0, "10th_percentile": 81.48, "90th_percentile": 97.0, "count": "22" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.62, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 77.24, "10th_percentile": 77.24, "90th_percentile": 77.24, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 83.13, "10th_percentile": 81.56, "90th_percentile": 83.13, "count": "44" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 25.84, "10th_percentile": 25.84, "90th_percentile": 25.84, "count": "20" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC PERQ PLCMT BILE DUCT STENT,NEW ACCESS WO SEP CATH", "code_information": [ { "code": "47539", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19083.1, "discounted_cash": 5965.0, "minimum": 5724.93, "maximum": 19083.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19083.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19083.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19083.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6502.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10088.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC I&D THIGH/KNEE ABSCESS,DEEP", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10259.7, "discounted_cash": 2866.0, "minimum": 2866.09, "maximum": 10259.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4847.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC B-12 BINDING CAPACITY", "code_information": [ { "code": "82608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 14.0, "minimum": 13.9162, "maximum": 188.57, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.92, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L4350) ANKLE CONTROL ORTHO PRE OTS", "code_information": [ { "code": "L4350", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 119.0, "minimum": 115.9649, "maximum": 201.8109, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.95, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.96, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 201.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1686) HO POST-OP HIP ABDUCTION", "code_information": [ { "code": "L1686", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1155.0, "minimum": 1123.0704, "maximum": 1954.4522, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1403.78, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1123.07, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1259.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1954.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C9361) NEUROMEND NERVE WRAP", "code_information": [ { "code": "C9361", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 381.109, "maximum": 381.109, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 381.11 } ] } ] }, { "description": "Ampicillin Sodium For Inj 250 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "65219001401", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.29, "maximum": 1.29, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.29 } ] } ] }, { "description": "HC WITHDRAWAL OF ARTERIAL BLOOD", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.56, "discounted_cash": 131.0, "minimum": 46.968, "maximum": 156.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION (76376)", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1009.06, "minimum": 137.5043, "maximum": 879.9003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 542.47, "10th_percentile": 542.47, "90th_percentile": 542.47, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.5 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 254.77, "10th_percentile": 254.77, "90th_percentile": 254.77, "count": "1 through 10" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES - G0463 - 76100004", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.63, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 280.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 280.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 280.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ampicillin Sodium For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781340778", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.29, "maximum": 1.29, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.29 } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "497", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10237.0, "minimum": 9292.58, "maximum": 24338.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21833.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24338.75 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9292.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24338.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13438.33 } ] } ] }, { "description": "HC (SUP SHELL A6452) HIGH COMPRES BAND W>=3<5YD - A6452 - 27100027", "code_information": [ { "code": "A6452", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.1631, "maximum": 14.2061, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF OXALATE", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.56, "discounted_cash": 14.0, "minimum": 14.0425, "maximum": 184.4803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT VENTR PM W TRANSVENOUS ELECTRODE", "code_information": [ { "code": "33207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38988.8, "discounted_cash": 10313.0, "minimum": 10313.01, "maximum": 38988.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38988.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38988.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38988.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11241.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17441.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITH CCMCC", "code_information": [ { "code": "052", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14823.0, "minimum": 11215.4354, "maximum": 56114.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32729.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56114.34 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14823.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13929.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14823.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56114.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14823.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20144.7 } ] } ] }, { "description": "HC (SUP SHELL C2625) STENT NON-COR TEMP W/DELIV SYSTEM", "code_information": [ { "code": "C2625", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 208.93, "10th_percentile": 208.93, "90th_percentile": 208.93, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 220.4, "10th_percentile": 220.4, "90th_percentile": 220.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 220.4, "10th_percentile": 206.02, "90th_percentile": 250.7, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4428) URINE OST POUCH W FAUCET/TAP", "code_information": [ { "code": "A4428", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 9.028, "maximum": 15.7112, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EXPOSE FEMORAL ART, GROIN INCIS UNI (AAA REPR)", "code_information": [ { "code": "34812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1609.38, "minimum": 482.814, "maximum": 1609.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 1609.38 } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [ { "code": "242", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25330.0, "minimum": 23477.15, "maximum": 88478.321, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57693.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 69115.65 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23477.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69115.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35509.3 } ] } ] }, { "description": "Metronidazole IV Soln 500 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00409015201", "type": "NDC" }, { "code": "J1836", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC HEMOGLOBIN ELECTROPHORESIS", "code_information": [ { "code": "83020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.13, "discounted_cash": 12.0, "minimum": 12.5071, "maximum": 203.2894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROTEIN TOT XCPT REFRACTOMETRY SERUM", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.38, "discounted_cash": 3.0, "minimum": 3.5665, "maximum": 82.2994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 50.74, "10th_percentile": 48.38, "90th_percentile": 60.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 48.09, "10th_percentile": 48.09, "90th_percentile": 48.09, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 48.43, "10th_percentile": 48.43, "90th_percentile": 51.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 16.4, "10th_percentile": 16.4, "90th_percentile": 60.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 66.44, "10th_percentile": 63.36, "90th_percentile": 66.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6216) NON-STERILE GAUZE<=16 SQ IN - A6216 - 27100086", "code_information": [ { "code": "A6216", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERCUT BIOPSY, ABDOMINAL MASS", "code_information": [ { "code": "49180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1909.06, "discounted_cash": 1629.0, "minimum": 572.718, "maximum": 1909.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1909.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1909.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1909.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1168.3, "10th_percentile": 1168.3, "90th_percentile": 1168.3, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1198.89, "10th_percentile": 1198.89, "90th_percentile": 1198.89, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1909.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRACHEOTOMY ER CRICOTHROID MEMBRANE", "code_information": [ { "code": "31605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3653.44, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 3185.7997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1118.42, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 894.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED DX RADIOGRAPHIC PROCEDURE", "code_information": [ { "code": "76499", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.75, "discounted_cash": 85.0, "minimum": 56.625, "maximum": 188.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 188.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 188.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 188.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A2002) MIRRAGEN ADV WND MAT PER SQ", "code_information": [ { "code": "A2002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ampicillin & Sulbactam Sodium For Inj 3 (2-1) GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00049001481", "type": "NDC" }, { "code": "J0295", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.3755, "maximum": 3.3755, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.38 } ] } ] }, { "description": "HC CYTOPATH, CELL ENHANCE TECH", "code_information": [ { "code": "88112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.38, "discounted_cash": 51.0, "minimum": 50.814, "maximum": 169.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 135.5, "10th_percentile": 135.5, "90th_percentile": 135.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 169.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 169.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 118.16, "10th_percentile": 118.16, "90th_percentile": 118.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TOE FX W MANIP EA", "code_information": [ { "code": "28515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 424.38, "discounted_cash": 243.0, "minimum": 127.314, "maximum": 424.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 424.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 424.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 424.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TOBACCO CESSATION ASYMPTOMATIC 3-10 MIN", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.69, "discounted_cash": 36.0, "minimum": 19.407, "maximum": 64.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 64.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ NERV BLCK, INTERCOSTAL, SINGLE", "code_information": [ { "code": "64420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3512.81, "discounted_cash": 696.0, "minimum": 696.49, "maximum": 3333.1922, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LYME DISEASE ANTIBODY, CONFIRMATORY", "code_information": [ { "code": "86617", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.38, "discounted_cash": 15.0, "minimum": 15.0532, "maximum": 121.5394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 138.48, "10th_percentile": 138.48, "90th_percentile": 138.48, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 150.01, "10th_percentile": 144.32, "90th_percentile": 150.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 138.48, "10th_percentile": 138.48, "90th_percentile": 138.48, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 194.46, "10th_percentile": 162.56, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BYPASS W/VEIN FEMORAL-POPLITEAL", "code_information": [ { "code": "35556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6385.0, "minimum": 1915.5, "maximum": 6385.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6385.0 } ] } ] }, { "description": "HC ASSAY OF METHADONE - 80358 - 30100205", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.38, "minimum": 58.314, "maximum": 169.4994, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.84 } ] } ] }, { "description": "HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC", "code_information": [ { "code": "25065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4690.31, "discounted_cash": 1629.0, "minimum": 1407.093, "maximum": 4690.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4690.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4690.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4690.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR SINGLE TRANSVEN ELECTROD/PM/DEFIB", "code_information": [ { "code": "33218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7560.31, "discounted_cash": 3687.0, "minimum": 2268.093, "maximum": 7560.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4019.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6235.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cangrelor Tetrasodium For IV Soln 50 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "10122062001", "type": "NDC" }, { "code": "C9460", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 20.0, "minimum": 19.4554, "maximum": 78.8787, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.46, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TEAEC W/WO PATCH GRAFT COMMON FEMORAL", "code_information": [ { "code": "35371", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12131.3, "minimum": 2944.0066, "maximum": 10578.4936, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2944.01 } ] } ] }, { "description": "HC PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS - 62267 - 36162267", "code_information": [ { "code": "62267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1589.38, "discounted_cash": 698.0, "minimum": 476.814, "maximum": 1589.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1589.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1589.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1589.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIGITAL BREAST TOMOSYNTHESIS BILAT - 77062 - 40100011", "code_information": [ { "code": "77062", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 796.88, "minimum": 239.064, "maximum": 796.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 510.0, "10th_percentile": 510.0, "90th_percentile": 510.0, "count": "12" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 404.18, "10th_percentile": 404.18, "90th_percentile": 404.18, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 495.59, "10th_percentile": 486.22, "90th_percentile": 495.59, "count": "25" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 796.88 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 500.44, "10th_percentile": 500.44, "90th_percentile": 510.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 555.9, "10th_percentile": 488.71, "90th_percentile": 561.0, "count": "19" } ] } ] }, { "description": "HC INJ DX/THER SBST INTRLMNR LMBR/SAC WO IMG", "code_information": [ { "code": "62322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3057.81, "discounted_cash": 872.0, "minimum": 872.7, "maximum": 3057.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3057.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3057.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3057.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6441) PAD BAND W>=3 <5/YD", "code_information": [ { "code": "A6441", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.6405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6204) COMPOSITE DRSG >16<=48 SQ IN - A6204 - RU272042", "code_information": [ { "code": "A6204", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.6101, "maximum": 14.984, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN A", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.06, "discounted_cash": 11.0, "minimum": 11.2826, "maximum": 173.5803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 107.02, "10th_percentile": 107.02, "90th_percentile": 107.02, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 101.44, "10th_percentile": 101.44, "90th_percentile": 101.44, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 109.18, "10th_percentile": 107.13, "90th_percentile": 109.18, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 51.9, "10th_percentile": 51.9, "90th_percentile": 127.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 138.87, "10th_percentile": 138.87, "90th_percentile": 140.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ceftolozane-Tazobactam For Inj 1.5 GM (1-0.5 GM)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "67919003001", "type": "NDC" }, { "code": "J0695", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.8142, "maximum": 34.8103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TALUS FX W MANIP", "code_information": [ { "code": "28435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2257.81, "discounted_cash": 1586.0, "minimum": 677.343, "maximum": 2257.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2257.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2257.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2257.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2257.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP", "code_information": [ { "code": "25606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11957.5, "discounted_cash": 3228.0, "minimum": 3228.48, "maximum": 11957.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11957.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11957.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11957.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THROMBOLYSIS ARTERIAL INFUSION W/IMG INIT TX", "code_information": [ { "code": "37211", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3611.56, "discounted_cash": 5490.0, "minimum": 1083.468, "maximum": 3611.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEPARIN NEUTRALIZATION", "code_information": [ { "code": "85525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.56, "discounted_cash": 11.0, "minimum": 11.5061, "maximum": 167.0403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO ADRENAL UNILAT SELECT", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1634.06, "discounted_cash": 3115.0, "minimum": 490.218, "maximum": 1634.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 877.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, DORSAL SPINE", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2612.81, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2278.3703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 245.16, "10th_percentile": 245.16, "90th_percentile": 490.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1594.23, "10th_percentile": 1594.23, "90th_percentile": 1594.23, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1108.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1822.7, "10th_percentile": 1822.7, "90th_percentile": 1822.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MASSAGE THERAPY EA 15 MIN", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.5, "discounted_cash": 28.0, "minimum": 27.3853, "maximum": 176.58, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COCCIDIOIDES, ANTIBODY", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.56, "discounted_cash": 11.0, "minimum": 11.1465, "maximum": 71.1203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KCl 40 MEQ/L (0.3%) in Dextrose 5% & NaCl 0.45% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338067504", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL C2617) STENT NON-COR TEMP W/O DELIV SYSTEM", "code_information": [ { "code": "C2617", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 180.6, "10th_percentile": 180.6, "90th_percentile": 365.57, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 219.28, "10th_percentile": 208.93, "90th_percentile": 634.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 422.4, "10th_percentile": 220.4, "90th_percentile": 913.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 220.4, "10th_percentile": 220.4, "90th_percentile": 220.4, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L1830) KO IMMOB CANVAS LONG PRE OTS", "code_information": [ { "code": "L1830", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 74.0, "minimum": 72.6809, "maximum": 126.4848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.85, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.68, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.48, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "658", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12850.0, "minimum": 10409.68, "maximum": 38867.0705, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28040.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 34102.29, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 36427.46, "10th_percentile": 36427.46, "90th_percentile": 36427.46, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36305.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12850.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10409.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12850.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36305.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12850.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17258.62 } ] } ] }, { "description": "Antithrombin III (Human) For Inj 500 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "13533060612", "type": "NDC" }, { "code": "J7197", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 3.9844, "maximum": 16.1524, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.98, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HPV HIGH-RISK TYPES", "code_information": [ { "code": "87624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.31, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 192.1103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 133.0, "10th_percentile": 111.72, "90th_percentile": 133.0, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 105.9, "10th_percentile": 105.9, "90th_percentile": 112.27, "count": "35" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 113.98, "10th_percentile": 113.98, "90th_percentile": 118.56, "count": "66" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 156.85, "10th_percentile": 156.85, "90th_percentile": 156.85, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 146.3, "10th_percentile": 146.3, "90th_percentile": 146.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS WITH MCC", "code_information": [ { "code": "592", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15766.0, "minimum": 14232.33, "maximum": 41854.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34970.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41854.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15766.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14232.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15766.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41854.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15766.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21523.79 } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [ { "code": "371", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14533.0, "minimum": 12098.48, "maximum": 41500.1813, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32039.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26943.68 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14533.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12098.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14533.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26943.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14533.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19719.85 } ] } ] }, { "description": "HC NM BOWEL IMAGING", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1090.63, "discounted_cash": 394.0, "minimum": 327.189, "maximum": 1090.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1090.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8600) IMPLANT BREAST SILICONE/EQ", "code_information": [ { "code": "L8600", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 771.0, "minimum": 749.3939, "maximum": 1304.152, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 936.7, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 749.39, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 840.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1304.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RENAL FUNCTION PANEL", "code_information": [ { "code": "80069", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.19, "discounted_cash": 8.0, "minimum": 8.4352, "maximum": 189.3897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 131.2, "10th_percentile": 131.2, "90th_percentile": 131.2, "count": "21" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.54, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 110.68, "10th_percentile": 104.47, "90th_percentile": 110.68, "count": "11" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 116.88, "10th_percentile": 112.44, "90th_percentile": 116.88, "count": "18" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 144.32, "10th_percentile": 144.32, "90th_percentile": 144.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVE FOREIGN BODY COMPLEX", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1211.56, "discounted_cash": 1629.0, "minimum": 363.468, "maximum": 1211.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4424) OST PCH DRAIN W BAR & FILTER - A4424 - RU272037", "code_information": [ { "code": "A4424", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.5888, "maximum": 11.4663, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.59, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.39, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICROSLIDE CONSULT", "code_information": [ { "code": "88321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1369.06, "discounted_cash": 36.0, "minimum": 36.85, "maximum": 1193.8203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.35, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.09, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 626.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY LUMBAR SPINE 2/3 VW", "code_information": [ { "code": "72100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 705.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 615.3094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 426.0, "10th_percentile": 426.0, "90th_percentile": 426.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 357.89, "10th_percentile": 337.61, "90th_percentile": 715.78, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 430.54, "10th_percentile": 413.97, "90th_percentile": 430.54, "count": "16" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 114.48, "10th_percentile": 114.48, "90th_percentile": 119.17, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 468.6, "10th_percentile": 207.32, "90th_percentile": 492.24, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT A-C JT DISLOC WO MANIP", "code_information": [ { "code": "23540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.94, "discounted_cash": 243.0, "minimum": 90.282, "maximum": 300.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EX FOR SPEECH DEVICE RX EA ADD 30 MIN", "code_information": [ { "code": "92608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 480.94, "discounted_cash": 45.0, "minimum": 44.5182, "maximum": 419.3797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.52, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4616) TUBING (OXYGEN) PER FOOT", "code_information": [ { "code": "A4616", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16112.0, "minimum": 13533.97, "maximum": 54602.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35792.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 54602.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16112.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13533.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16112.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54602.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16112.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22029.82 } ] } ] }, { "description": "HC PENILE VASCULAR STUDY,LTD OR F/U", "code_information": [ { "code": "93981", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1222.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1066.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOUS CUTDOWN >1 Y/O", "code_information": [ { "code": "36425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1008.75, "discounted_cash": 440.0, "minimum": 302.625, "maximum": 1008.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1008.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1008.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1008.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 745.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4409) OST SKN BARR CONVEX <=4 SQ I", "code_information": [ { "code": "A4409", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.5907, "maximum": 14.9502, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6210) FOAM DRG >16<=48 SQ IN W/O B - A6210 - RU272043", "code_information": [ { "code": "A6210", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 28.0, "minimum": 27.5991, "maximum": 48.0301, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEART INFARCT IMAGE", "code_information": [ { "code": "78466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 792.5, "discounted_cash": 394.0, "minimum": 237.75, "maximum": 792.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 792.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 792.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 792.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 792.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF AMITRIPTYLINE - G0480 - 30100408", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.25, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EX FOR NONSPEECH DEVICE RX INIT HR", "code_information": [ { "code": "92605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 638.13, "minimum": 95.0, "maximum": 556.4494, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC CT ANGIO,NECK COMBO,INCL IMAGE PROCESS", "code_information": [ { "code": "70498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1901.25, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1763.8241, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 964.32, "10th_percentile": 964.32, "90th_percentile": 964.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1160.07, "10th_percentile": 1115.57, "90th_percentile": 1160.07, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1763.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 726.24, "10th_percentile": 726.24, "90th_percentile": 726.24, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1326.31, "10th_percentile": 583.0, "90th_percentile": 1326.31, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC", "code_information": [ { "code": "917", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12976.0, "minimum": 11348.9, "maximum": 32337.066, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 29110.78, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 29187.42, "10th_percentile": 29187.42, "90th_percentile": 29187.42, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28340.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25597.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11348.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25597.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17443.24 } ] } ] }, { "description": "HC I&D ARM/ELBOW INFECT BURSA", "code_information": [ { "code": "23931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1144.06, "discounted_cash": 1629.0, "minimum": 343.218, "maximum": 1144.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THYROID MET IMAGING LTD", "code_information": [ { "code": "78015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1523.44, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1523.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1523.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1523.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1523.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "738", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12216.0, "minimum": 10498.97, "maximum": 34322.8583, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26535.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31672.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12216.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10498.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12216.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31672.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12216.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16332.19 } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [ { "code": "140", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33487.0, "minimum": 9595.6, "maximum": 77073.2886, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 77073.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9595.6 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33487.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29271.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33487.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9595.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 33487.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47437.3 } ] } ] }, { "description": "HC DIGITAL BREAST TOMOSYNTHESIS UNILAT - G0279 - 40100010", "code_information": [ { "code": "G0279", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.88, "discounted_cash": 11.0, "minimum": 11.3506, "maximum": 694.8794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "370", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6377.0, "minimum": 4831.09, "maximum": 13704.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12663.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13704.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6377.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4831.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6377.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13704.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6377.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7794.07 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [ { "code": "687", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9016.0, "minimum": 7286.08, "maximum": 21049.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18933.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 17059.86, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13534.42, "10th_percentile": 13534.42, "90th_percentile": 13534.42, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21049.93 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9016.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7286.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9016.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21049.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9016.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11653.3 } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11884.0, "minimum": 10129.37, "maximum": 25926.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25745.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25926.65 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11884.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10129.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11884.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25926.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11884.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15846.17 } ] } ] }, { "description": "HC CLSD TREAT POST HIP FIX DISLOC W ANES", "code_information": [ { "code": "27266", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7210.31, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 7210.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6250.61, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7210.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6074.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3980) UPP EXT FX ORTHOSIS HUMERAL", "code_information": [ { "code": "L3980", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 463.0, "minimum": 450.4293, "maximum": 783.8712, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 563.01, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 450.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 505.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 783.87, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FACTOR INHIBITOR TEST", "code_information": [ { "code": "85335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 601.25, "discounted_cash": 12.0, "minimum": 12.5071, "maximum": 524.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY JOINT SURVEY SINGLE VW", "code_information": [ { "code": "77077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 390.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 390.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 390.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 390.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 269.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC", "code_information": [ { "code": "496", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14767.0, "minimum": 13655.78, "maximum": 109576.331, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43904.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14767.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13655.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14767.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43904.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14767.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20062.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32596.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Atropine Sulfate Inj 0.4 MG/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00641625101", "type": "NDC" }, { "code": "J0461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 19.41, "10th_percentile": 19.41, "90th_percentile": 19.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16632.0, "minimum": 13524.28, "maximum": 39022.8574, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37026.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27820.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13524.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27820.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22789.43 } ] } ] }, { "description": "HC BACTERIUM, ANTIBODY", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 422.5, "discounted_cash": 12.0, "minimum": 12.5168, "maximum": 368.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7190.0, "minimum": 5612.51, "maximum": 19322.4457, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14593.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14569.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7190.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5612.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7190.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14569.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7190.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8981.87 } ] } ] }, { "description": "HC SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK", "code_information": [ { "code": "67930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9625.0, "discounted_cash": 2345.0, "minimum": 2345.87, "maximum": 9625.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9241.79, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9625.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8981.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2557.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3967.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6242) HYDROGEL DRG <=16 IN W/O BDR", "code_information": [ { "code": "A6242", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.3866, "maximum": 14.5951, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.41, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ED LEVEL 2", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 523.13, "discounted_cash": 151.0, "minimum": 151.49, "maximum": 523.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 244.61, "10th_percentile": 244.61, "90th_percentile": 291.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 523.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 523.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 523.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 308.91, "10th_percentile": 279.92, "90th_percentile": 559.84, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 282.97, "10th_percentile": 282.97, "90th_percentile": 319.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 406.68, "10th_percentile": 320.82, "90th_percentile": 585.49, "count": "14" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 288.29, "10th_percentile": 288.29, "90th_percentile": 288.29, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 364.93, "10th_percentile": 364.93, "90th_percentile": 364.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 256.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11974.0, "minimum": 10079.53, "maximum": 43536.5603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 39192.89, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 25600.1, "10th_percentile": 25600.1, "90th_percentile": 25600.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25960.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 38199.34, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 33422.67, "10th_percentile": 33422.67, "90th_percentile": 33422.67, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21548.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11974.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10079.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11974.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21548.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11974.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15978.52 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "356", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34456.0, "minimum": 29524.32, "maximum": 80541.3116, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 79377.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 64751.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 34456.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29524.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34456.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 64751.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 34456.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48855.32 } ] } ] }, { "description": "HC ASSAY BLOOD CARBON DIOXIDE", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.19, "discounted_cash": 4.0, "minimum": 4.7424, "maximum": 41.1497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.37, "10th_percentile": 25.37, "90th_percentile": 30.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 24.05, "10th_percentile": 24.05, "90th_percentile": 24.05, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 25.88, "10th_percentile": 25.88, "90th_percentile": 25.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 32.92, "10th_percentile": 32.92, "90th_percentile": 32.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [ { "code": "557", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12356.0, "minimum": 10725.99, "maximum": 34315.7346, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16536.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26868.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21307.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12356.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10725.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12356.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21307.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12356.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC SEMEN ANALYSIS,MOTIL & COUNT W/O HUHNER", "code_information": [ { "code": "89310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.5, "discounted_cash": 8.0, "minimum": 8.3672, "maximum": 137.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [ { "code": "598", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9652.0, "minimum": 7342.15, "maximum": 26117.1674, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20442.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17363.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9652.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7342.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9652.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17363.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9652.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12581.96 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16016.0, "minimum": 13559.58, "maximum": 50357.4686, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35565.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 42738.93 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16016.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13559.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16016.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42738.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 50357.47, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15796.33, "10th_percentile": 15796.33, "90th_percentile": 35190.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16016.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21889.69 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15426.0, "minimum": 13133.92, "maximum": 39783.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34161.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39783.29 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13133.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39783.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21025.54 } ] } ] }, { "description": "HC TRANSABDOMINAL AMNIOINFUSION W/ULTRSND GUIDANCE", "code_information": [ { "code": "59070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 478.44, "discounted_cash": 300.0, "minimum": 143.532, "maximum": 478.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 478.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 478.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 478.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1889) IMPLANT/INSERT DEVICE, NOC - C1889 - 27201889", "code_information": [ { "code": "C1889", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 6405.84, "10th_percentile": 660.07, "90th_percentile": 6405.84, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1412.1, "10th_percentile": 1412.1, "90th_percentile": 1412.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 876.42, "10th_percentile": 752.99, "90th_percentile": 876.42, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 2538.76, "10th_percentile": 665.92, "90th_percentile": 5397.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 996.91, "10th_percentile": 309.32, "90th_percentile": 5997.2, "count": "1 through 10" } ] } ] }, { "description": "HC CHYLMD TRACH, DNA, AMP PROBE", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.56, "discounted_cash": 35.0, "minimum": 33.468, "maximum": 111.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 67.4, "10th_percentile": 56.62, "90th_percentile": 89.25, "count": "34" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 53.67, "10th_percentile": 53.67, "90th_percentile": 56.85, "count": "26" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 60.04, "10th_percentile": 57.76, "90th_percentile": 60.04, "count": "37" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 84.25, "10th_percentile": 67.4, "90th_percentile": 89.25, "count": "16" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 77.83, "10th_percentile": 77.83, "90th_percentile": 77.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CALCULUS ASSAY,INFRARED SPECTR", "code_information": [ { "code": "82365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.88, "discounted_cash": 12.0, "minimum": 12.5362, "maximum": 271.9594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 167.66, "10th_percentile": 167.66, "90th_percentile": 167.66, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 167.84, "10th_percentile": 167.84, "90th_percentile": 171.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 67.69, "10th_percentile": 67.47, "90th_percentile": 219.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4411) OST SKN BARR EXTND =4SQ", "code_information": [ { "code": "A4411", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.0553, "maximum": 12.2781, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT MT-PHAL TOE DISLOC W ANES", "code_information": [ { "code": "28635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2052.81, "discounted_cash": 1586.0, "minimum": 615.843, "maximum": 2052.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLACE BILE CATH, CHOLANGIO, PERQ EXTERNAL", "code_information": [ { "code": "47533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16418.8, "discounted_cash": 3532.0, "minimum": 3532.78, "maximum": 16418.8, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13917.74, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16418.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13525.95, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC NM GASTRIC EMPTYING STUDY", "code_information": [ { "code": "78264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1104.38, "discounted_cash": 394.0, "minimum": 331.314, "maximum": 1104.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 593.71, "10th_percentile": 593.71, "90th_percentile": 593.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1104.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT BIG TOE FX W MANIP", "code_information": [ { "code": "28495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.94, "discounted_cash": 243.0, "minimum": 90.282, "maximum": 300.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITH CCMCC", "code_information": [ { "code": "600", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8969.0, "minimum": 6620.94, "maximum": 18821.5453, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18821.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8790.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8969.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6620.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8969.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8790.94 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8969.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11584.34 } ] } ] }, { "description": "Infliximab For IV Inj 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "57894016001", "type": "NDC" }, { "code": "J1745", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 31.0, "minimum": 30.2133, "maximum": 122.2891, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 122.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.77, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.21, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY UREA NITROGEN, QUAN", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.81, "discounted_cash": 3.0, "minimum": 3.8386, "maximum": 63.4903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 46.6, "10th_percentile": 39.14, "90th_percentile": 46.6, "count": "12" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.84, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 37.11, "10th_percentile": 37.11, "90th_percentile": 37.11, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 39.94, "10th_percentile": 39.18, "90th_percentile": 39.94, "count": "16" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.66, "10th_percentile": 17.66, "90th_percentile": 39.14, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 50.79, "10th_percentile": 50.79, "90th_percentile": 51.26, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [ { "code": "064", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16342.0, "minimum": 13767.91, "maximum": 45494.806, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36338.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 45061.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16342.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13767.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16342.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45061.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16342.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22365.7 } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITH MCC", "code_information": [ { "code": "500", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25117.0, "minimum": 21931.62, "maximum": 70451.1668, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57187.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 66072.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25117.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21931.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25117.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66072.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25117.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35197.89 } ] } ] }, { "description": "PNEUMOTHORAX WITH CC", "code_information": [ { "code": "200", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9408.0, "minimum": 7665.37, "maximum": 21408.5371, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19864.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13461.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9408.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7665.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9408.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13461.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9408.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12226.06 } ] } ] }, { "description": "HC (SUP SHELL Q4130) STRATTICE TM", "code_information": [ { "code": "Q4130", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OP CARDIAC REHAB W CONT ECG MONIT PER SESSION", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.31, "discounted_cash": 127.0, "minimum": 48.093, "maximum": 160.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0462) TLSO 3MOD SACRO-SCAP PRE", "code_information": [ { "code": "L0462", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1497.0, "minimum": 1455.4551, "maximum": 2532.8933, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1819.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1455.46, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1632.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2532.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [ { "code": "871", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15821.0, "minimum": 13580.34, "maximum": 46859.9621, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 42184.71, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 35783.91, "10th_percentile": 20522.27, "90th_percentile": 36744.61, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35100.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 39873.96, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22041.89, "10th_percentile": 22041.89, "90th_percentile": 22041.89, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29846.72 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 46752.49, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 35100.66, "10th_percentile": 35100.66, "90th_percentile": 35100.66, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13580.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29846.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 46859.96, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18504.33, "10th_percentile": 18504.33, "90th_percentile": 18504.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21603.86 } ] } ] }, { "description": "HC ENZYME CELL ACTIVITY", "code_information": [ { "code": "82657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.63, "discounted_cash": 22.0, "minimum": 21.5448, "maximum": 331.9094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.93, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.54, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VASOPNEUMATIC DEVICE THERAPY", "code_information": [ { "code": "97016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.06, "discounted_cash": 11.0, "minimum": 11.1174, "maximum": 121.2603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT ACETABULAR FX WO MANIP", "code_information": [ { "code": "27220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1005.0, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 1005.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1005.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Neostigmine Methylsulfate Inj 1 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00641614901", "type": "NDC" }, { "code": "J2710", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.763, "maximum": 1.763, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 146.93, "10th_percentile": 142.82, "90th_percentile": 289.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.76 } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES", "code_information": [ { "code": "769", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13899.0, "minimum": 9525.83, "maximum": 30534.4156, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30534.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26441.02 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13899.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9525.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13899.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26441.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13899.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18793.41 } ] } ] }, { "description": "HC INJ NERV BLCK,OTHR PERIPH NERV", "code_information": [ { "code": "64450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1647.81, "discounted_cash": 696.0, "minimum": 494.343, "maximum": 1647.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1647.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1647.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH", "code_information": [ { "code": "33361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19628.8, "minimum": 5888.64, "maximum": 19628.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19628.8 } ] } ] }, { "description": "HC MRI LOWER EXTREM JT, W/O CONTRAST", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2882.5, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2513.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1434.55, "10th_percentile": 1291.42, "90th_percentile": 1434.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1269.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 563.85, "10th_percentile": 563.85, "90th_percentile": 563.85, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1878.58, "10th_percentile": 1878.58, "90th_percentile": 1878.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "117", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9299.0, "minimum": 7005.77, "maximum": 23462.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19603.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23461.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9299.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7005.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9299.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23462.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9299.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12065.91 } ] } ] }, { "description": "HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX", "code_information": [ { "code": "61050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1102.19, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1102.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1102.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1102.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1102.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hydrocortisone Sodium Succinate PF For Inj 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009001103", "type": "NDC" }, { "code": "J1720", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 44.247, "maximum": 44.247, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.25 } ] } ] }, { "description": "HC CLSD TREAT HUM SUPRACONDYLR FX W MANIP", "code_information": [ { "code": "24535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5930.94, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 5930.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5930.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5930.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5930.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEBRIDEMENT OF NAILS, 6 OR MORE", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.63, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 283.9494, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "REHABILITATION WITHOUT CCMCC", "code_information": [ { "code": "946", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9769.0, "minimum": 7727.66, "maximum": 24800.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20722.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24800.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9769.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7727.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9769.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24800.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9769.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12754.34 } ] } ] }, { "description": "HC CLOSTRIDIUM AG, EIA", "code_information": [ { "code": "87324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.31, "discounted_cash": 11.0, "minimum": 11.6422, "maximum": 235.7103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 83749.0, "minimum": 14608.7, "maximum": 196493.2471, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 196493.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14608.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 83749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75400.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 83749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14608.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 83749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 120938.26 } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "468", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21947.0, "minimum": 18156.72, "maximum": 54734.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 49655.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 54734.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21947.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18156.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21947.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54734.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21947.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30562.38 } ] } ] }, { "description": "HC ANGIO VISCERAL SELECTV/SUBSELEC", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9352.5, "discounted_cash": 5490.0, "minimum": 681.5709, "maximum": 9352.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9352.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9352.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9352.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1260.75, "10th_percentile": 1260.75, "90th_percentile": 1260.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 681.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF IRON", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.88, "discounted_cash": 6.0, "minimum": 6.2875, "maximum": 84.4794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 62.0, "10th_percentile": 52.08, "90th_percentile": 62.0, "count": "37" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 49.37, "10th_percentile": 49.37, "90th_percentile": 49.37, "count": "21" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 52.13, "10th_percentile": 52.13, "90th_percentile": 53.13, "count": "76" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 28.92, "10th_percentile": 28.92, "90th_percentile": 62.0, "count": "14" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 67.58, "10th_percentile": 33.95, "90th_percentile": 68.2, "count": "125" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF FOR HVA", "code_information": [ { "code": "83150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 574.38, "discounted_cash": 22.0, "minimum": 21.778, "maximum": 500.8594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PR REFOREARM TEND/MUSC,FLEX,PRIM,EA", "code_information": [ { "code": "25260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15120.6, "discounted_cash": 3228.0, "minimum": 3228.48, "maximum": 15120.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12718.92, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15120.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12360.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25543.0, "minimum": 22012.6, "maximum": 58199.3407, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58199.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44358.01 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25543.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22012.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25543.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44358.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25543.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35820.71 } ] } ] }, { "description": "HC XRAY UPPER GI AIR CONTRAST", "code_information": [ { "code": "74246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.69, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1028.6897, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 712.2, "10th_percentile": 712.2, "90th_percentile": 712.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 598.34, "10th_percentile": 598.34, "90th_percentile": 598.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 851.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 822.95, "10th_percentile": 822.95, "90th_percentile": 822.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY OPER CHOLANGIO ADDNL SET", "code_information": [ { "code": "74301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1532.19, "minimum": 157.9777, "maximum": 1336.0697, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.98 } ] } ] }, { "description": "HC X-RAY NOSE-RECTUM CHILD F.B.", "code_information": [ { "code": "76010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 436.88, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 221.59, "10th_percentile": 221.59, "90th_percentile": 221.59, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5353.0, "minimum": 3872.48, "maximum": 13321.3498, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 10229.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9083.19 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 13290.8, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 10110.08, "10th_percentile": 10110.08, "90th_percentile": 10110.08, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5353.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3872.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5353.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9083.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 13321.35, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13906.12, "10th_percentile": 13906.12, "90th_percentile": 13906.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5353.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6295.98 } ] } ] }, { "description": "HC MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS", "code_information": [ { "code": "93025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 894.06, "discounted_cash": 126.0, "minimum": 126.95, "maximum": 779.6203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 500.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 607.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 486.05, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PANCREAS TRANSPLANT", "code_information": [ { "code": "010", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55621.0, "minimum": 53414.4, "maximum": 155186.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 129663.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 155185.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 55621.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55183.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55621.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 155186.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 55621.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79805.84 } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "092", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8828.0, "minimum": 7327.61, "maximum": 26516.4272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18485.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18939.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8828.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7327.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8828.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18939.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8828.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11377.48 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15185.0, "minimum": 12290.9, "maximum": 66370.0695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33590.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39662.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15185.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12290.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15185.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39662.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15185.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20674.09 } ] } ] }, { "description": "HC CT SCAN MAXILLOFACIAL AREA COMBO", "code_information": [ { "code": "70488", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2499.06, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2179.1803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1137.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN", "code_information": [ { "code": "76512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 591.0503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF SEROTONIN", "code_information": [ { "code": "84260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.94, "discounted_cash": 30.0, "minimum": 30.1064, "maximum": 340.8997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.11, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CARDIOVERSION, ELECTIVE;INTERN", "code_information": [ { "code": "92961", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1796.25, "discounted_cash": 652.0, "minimum": 538.875, "maximum": 1796.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1796.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1796.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1796.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 710.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1102.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C9352) MICROPOROUS COLL IMPLANTBLE TUBE CM", "code_information": [ { "code": "C9352", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2276.334, "maximum": 2276.334, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2276.33 } ] } ] }, { "description": "HC OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES", "code_information": [ { "code": "28505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4149.69, "discounted_cash": 3228.0, "minimum": 1244.907, "maximum": 4149.69, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CYSTATIN C", "code_information": [ { "code": "82610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.69, "discounted_cash": 18.0, "minimum": 17.9977, "maximum": 291.8497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 82.78, "10th_percentile": 82.78, "90th_percentile": 82.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 170.56, "10th_percentile": 170.56, "90th_percentile": 170.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 97.18, "10th_percentile": 97.18, "90th_percentile": 97.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4351) STRAIGHT TIP URINE CATHETER", "code_information": [ { "code": "A4351", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.5072, "maximum": 4.3633, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.51, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY HEEL", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 465.0, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 280.8, "10th_percentile": 280.8, "90th_percentile": 280.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 272.87, "10th_percentile": 272.87, "90th_percentile": 272.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6255) ABSORPT DRG >16<=48 IN W/BDR - A6255 - 27200144", "code_information": [ { "code": "A6255", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.2176, "maximum": 7.3398, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.22, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY KNEE BILAT STANDING", "code_information": [ { "code": "73565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.31, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 390.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 390.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32759.0, "minimum": 11182.2056, "maximum": 90175.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 14961.7, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 1571.33, "10th_percentile": 1571.33, "90th_percentile": 3089.87, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75344.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 90175.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32759.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28865.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32759.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 90175.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 16619.88, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4746.44, "10th_percentile": 4746.44, "90th_percentile": 4746.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 32759.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46372.96 } ] } ] }, { "description": "HC X-RAY COLON AIR CONTRAST", "code_information": [ { "code": "74280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1600.63, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1409.8975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1409.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SKULL 4+ VW", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 775.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 675.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 274.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Rabies Virus Vaccine, HDC For Inj Susp", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "49281025251", "type": "NDC" }, { "code": "90675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 315.0, "minimum": 304.8342, "maximum": 1241.8368, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1461.1, "10th_percentile": 1461.1, "90th_percentile": 1461.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1241.84, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 381.03, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 304.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1690.26, "10th_percentile": 1690.26, "90th_percentile": 1690.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 682.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 343.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 533.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF HAPTOGLOBIN, QUANT", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.31, "discounted_cash": 12.0, "minimum": 12.2252, "maximum": 165.9503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 56.23, "10th_percentile": 56.23, "90th_percentile": 56.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 12.58, "10th_percentile": 12.58, "90th_percentile": 132.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TAR-METATAR DISLOC WO ANES", "code_information": [ { "code": "28600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANALYZE NEUROSTIM,COMPLX/PROG", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1094.38, "discounted_cash": 93.0, "minimum": 93.8, "maximum": 954.2994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 369.53, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 448.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 359.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 158.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6451) MOD COMPRES BAND W>=3<5/YD", "code_information": [ { "code": "A6451", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4295, "maximum": 4.228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVIS TRANSVEN INTRAHEP PORTOSYS SHUNT", "code_information": [ { "code": "37183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66127.2, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 57662.9184, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22124.32, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26875.92, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ECHO HEART XTHORACIC,LIMITED - C8924 - 48300002", "code_information": [ { "code": "C8924", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1870.94, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1647.3337, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SPINE ONE VIEW", "code_information": [ { "code": "72020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426.56, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF APOLIPOPROTEIN", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 21.0, "minimum": 20.4953, "maximum": 222.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 163.2, "10th_percentile": 145.4, "90th_percentile": 163.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 154.47, "10th_percentile": 85.04, "90th_percentile": 245.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 137.23, "10th_percentile": 89.81, "90th_percentile": 163.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 94.27, "10th_percentile": 94.27, "90th_percentile": 94.27, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 116.41, "10th_percentile": 110.66, "90th_percentile": 211.46, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.67, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8002) BRST PRSTH BRA & BILAT FORM", "code_information": [ { "code": "L8002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 198.0, "minimum": 192.6788, "maximum": 335.3142, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 240.84, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 192.68, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 335.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NASAL SMEAR FOR EOSINOPHILS", "code_information": [ { "code": "89190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.88, "discounted_cash": 5.0, "minimum": 5.6267, "maximum": 106.2794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.79, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT PULSE GENER SINGLE CHMBR", "code_information": [ { "code": "33212", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32764.1, "discounted_cash": 8165.0, "minimum": 8165.34, "maximum": 32764.1, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32168.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32764.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31262.64, "additional_payer_notes": "382.87% of Medicare Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [ { "code": "368", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13155.0, "minimum": 11558.62, "maximum": 29331.764, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28765.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22146.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11558.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22146.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17704.6 } ] } ] }, { "description": "HC PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL", "code_information": [ { "code": "0200T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25034.1, "discounted_cash": 7159.0, "minimum": 7159.72, "maximum": 25034.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25034.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25034.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25034.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12108.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHANGE EXT TRANSNEPH URETER STENT W/ FLUORO", "code_information": [ { "code": "50387", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4355.31, "discounted_cash": 2062.0, "minimum": 1306.593, "maximum": 4355.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4355.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4355.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4355.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT BIMALLEOLAR ANKLE FX W MANIP", "code_information": [ { "code": "27810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 560.0, "discounted_cash": 1586.0, "minimum": 168.0, "maximum": 560.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITHOUT CCMCC", "code_information": [ { "code": "798", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8327.0, "minimum": 6701.23, "maximum": 22057.4079, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 19856.73, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 14961.44, "10th_percentile": 14961.44, "90th_percentile": 14961.44, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17294.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8327.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6701.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8327.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8327.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10644.56 } ] } ] }, { "description": "HC PUNCTURE DRAINAGE OF LESION", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.31, "discounted_cash": 401.0, "minimum": 123.093, "maximum": 410.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN B-1", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.88, "discounted_cash": 21.0, "minimum": 20.6313, "maximum": 306.8394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 225.2, "10th_percentile": 225.2, "90th_percentile": 225.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 179.32, "10th_percentile": 179.32, "90th_percentile": 179.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 193.0, "10th_percentile": 189.37, "90th_percentile": 193.0, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 94.9, "10th_percentile": 94.9, "90th_percentile": 225.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 245.47, "10th_percentile": 245.47, "90th_percentile": 247.72, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TETANUS ANTIBODY", "code_information": [ { "code": "86774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.94, "discounted_cash": 14.0, "minimum": 14.3826, "maximum": 188.2997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 143.44, "10th_percentile": 143.44, "90th_percentile": 143.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4315) CATH W/DRAINAGE 2-WAY SILCNE", "code_information": [ { "code": "A4315", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 31.0, "minimum": 31.049, "maximum": 54.0338, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.05, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRANSCATHETER BIOPSY", "code_information": [ { "code": "37200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2220.94, "discounted_cash": 5490.0, "minimum": 666.282, "maximum": 2220.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CSF LEAKAGE DETECTION & LOCALIZATION", "code_information": [ { "code": "78650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.5, "discounted_cash": 1277.0, "minimum": 371.25, "maximum": 1237.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1237.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COAGULATION TIME, ACTIVATED", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.44, "discounted_cash": 4.0, "minimum": 4.1593, "maximum": 50.9597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prednisolone Sod Phosphate Oral Soln 15 MG/5ML (Base Equiv)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00121475905", "type": "NDC" }, { "code": "J7510", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.032, "maximum": 1.032, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.03 } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH MCC", "code_information": [ { "code": "653", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40568.0, "minimum": 38583.65, "maximum": 93898.1166, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 93898.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 79284.07 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 40568.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38583.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40568.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 79284.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 40568.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57792.7 } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "758", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8493.0, "minimum": 7054.91, "maximum": 26007.8726, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17690.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11717.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8493.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7054.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8493.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11717.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8493.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10888.12 } ] } ] }, { "description": "HC PERCUT MECH THROMBECTOMY, VENOUS, REPEAT", "code_information": [ { "code": "37188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12674.1, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 12674.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12273.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12674.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT ATRIAL PM W TRANSVENOUS ELECTRODE", "code_information": [ { "code": "33206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38988.8, "discounted_cash": 10313.0, "minimum": 10313.01, "maximum": 38988.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38988.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38988.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38988.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11241.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17441.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7508.0, "minimum": 5667.88, "maximum": 15348.5221, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15348.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10961.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7508.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5667.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7508.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10961.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7508.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9446.75 } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC", "code_information": [ { "code": "844", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10306.0, "minimum": 8272.37, "maximum": 21998.2232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21998.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20582.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10306.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8272.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10306.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20582.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10306.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13539.53 } ] } ] }, { "description": "HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT", "code_information": [ { "code": "34705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5869.38, "minimum": 1760.814, "maximum": 5869.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 5869.38 } ] } ] }, { "description": "Aminocaproic Acid Inj 250 MG/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409434616", "type": "NDC" }, { "code": "J0281", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.795, "maximum": 2.795, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.8 } ] } ] }, { "description": "HC ASSAY OF SIROLIMUS", "code_information": [ { "code": "80195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.81, "discounted_cash": 13.0, "minimum": 13.3428, "maximum": 155.0503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC ANTIBODY IDENTIFICATION", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.31, "discounted_cash": 353.0, "minimum": 136.593, "maximum": 455.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 244.78, "10th_percentile": 244.78, "90th_percentile": 244.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 455.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 455.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 455.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 385.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 317.63, "10th_percentile": 317.63, "90th_percentile": 317.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 455.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [ { "code": "336", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17085.0, "minimum": 14619.93, "maximum": 50074.5336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38103.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37768.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14619.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37768.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23452.29 } ] } ] }, { "description": "Methacholine Chloride Inhal For Soln 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "64281010000", "type": "NDC" }, { "code": "J7674", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.5045, "maximum": 3.5045, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.5 } ] } ] }, { "description": "HC SURG PATH,LEVEL IV", "code_information": [ { "code": "88305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 462.19, "discounted_cash": 51.0, "minimum": 51.42, "maximum": 403.0297, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.08, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 235.53, "10th_percentile": 235.53, "90th_percentile": 1848.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 140.85, "10th_percentile": 140.63, "90th_percentile": 422.55, "count": "56" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 231.06, "10th_percentile": 231.06, "90th_percentile": 322.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 248.47, "10th_percentile": 248.47, "90th_percentile": 566.73, "count": "96" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC DEBRIDE SKIN SUB-Q TISS =<20 SQ CM", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 591.56, "discounted_cash": 401.0, "minimum": 177.468, "maximum": 591.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY ALKALINE PHOSPHATASE ,ISOENZYMES", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.63, "discounted_cash": 14.0, "minimum": 14.3632, "maximum": 270.8694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.95, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 136.8, "10th_percentile": 136.8, "90th_percentile": 136.8, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 317.6, "10th_percentile": 317.6, "90th_percentile": 317.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 218.68, "10th_percentile": 218.68, "90th_percentile": 218.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RO SET RADN THERAPY FIELD COMPLEX", "code_information": [ { "code": "77290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2524.38, "discounted_cash": 369.0, "minimum": 369.45, "maximum": 2201.2594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1455.49, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1768.08, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1414.51, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 402.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 624.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10997.0, "minimum": 8794.93, "maximum": 36011.0346, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23638.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19900.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10997.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8794.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10997.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19900.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10997.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14549.38 } ] } ] }, { "description": "HC (SUP SHELL A4344) CATH INDW FOLEY 2 WAY SILICN - A4344 - 27200065", "code_information": [ { "code": "A4344", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 22.0, "minimum": 22.1668, "maximum": 38.5763, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.71, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.86, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ELECTRICAL STIMULATION EA 15 MIN", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.44, "discounted_cash": 14.0, "minimum": 13.6927, "maximum": 98.9197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5869.0, "minimum": 4875.38, "maximum": 13710.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11456.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13710.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4875.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13710.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7051.15 } ] } ] }, { "description": "HC CHLAMYDIA, ANTIBODY", "code_information": [ { "code": "86631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.44, "discounted_cash": 11.0, "minimum": 11.4867, "maximum": 85.8397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Pentobarbital Sodium Inj 50 MG/ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "25021067650", "type": "NDC" }, { "code": "J2515", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 36.0, "minimum": 36.838, "maximum": 145.127, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.33, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.15, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FRESH FROZEN PLASMA 24 PRODUCT", "code_information": [ { "code": "P9059", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.25, "discounted_cash": 73.0, "minimum": 73.41, "maximum": 336.25, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.15, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 289.21, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 336.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 281.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 206.22, "10th_percentile": 206.22, "90th_percentile": 206.22, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC HISTOPLASMA CAPSUL AG, EIA", "code_information": [ { "code": "87385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.81, "discounted_cash": 13.0, "minimum": 12.8764, "maximum": 181.2103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CCMCC", "code_information": [ { "code": "842", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8732.0, "minimum": 7280.55, "maximum": 31557.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18257.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31557.37 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8732.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7280.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8732.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31557.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8732.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11237.35 } ] } ] }, { "description": "HC (SUP SHELL Q4176) NEOPATCH OR THERION, 1 SQ CM", "code_information": [ { "code": "Q4176", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "072", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6799.0, "minimum": 5192.38, "maximum": 24319.8903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13664.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13198.1 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6799.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5192.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6799.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13198.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6799.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8410.21 } ] } ] }, { "description": "HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT", "code_information": [ { "code": "37182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66127.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 66127.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66127.2, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 54000.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66127.2, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5073) URINARY POUCH ON BARR W/FLNG", "code_information": [ { "code": "A5073", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.4023, "maximum": 7.6611, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PLEURAL EFFUSION WITH MCC", "code_information": [ { "code": "186", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12901.0, "minimum": 10935.7, "maximum": 28161.8456, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28161.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25546.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12901.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10935.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12901.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25546.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12901.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17333.14 } ] } ] }, { "description": "HC (SUP SHELL A4340) INDWELLING CATHETER SPECIAL - A4340 - 27200064", "code_information": [ { "code": "A4340", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 45.0, "minimum": 43.974, "maximum": 76.5268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.97, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC ANTIBODY ELUTION", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.5, "discounted_cash": 168.0, "minimum": 168.1, "maximum": 707.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 662.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 643.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10798.0, "minimum": 9204.68, "maximum": 27725.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23165.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27724.97 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10798.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9204.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10798.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27725.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10798.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14257.99 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10322.0, "minimum": 8599.06, "maximum": 47613.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22036.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47613.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10322.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8599.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10322.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47613.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10322.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13562.89 } ] } ] }, { "description": "HC CT SCAN ABDOMEN/PELVIS WO CONTRAST", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2415.63, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2106.4294, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1139.47, "10th_percentile": 1139.47, "90th_percentile": 1286.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 933.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 413.74, "10th_percentile": 413.39, "90th_percentile": 413.74, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1354.87, "10th_percentile": 1354.87, "90th_percentile": 1354.87, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 984.98, "10th_percentile": 984.98, "90th_percentile": 1172.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "Cyclosporine Cap 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00078024161", "type": "NDC" }, { "code": "J7502", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.343, "maximum": 4.343, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.34 } ] } ] }, { "description": "HC CLSD TREAT STERNO-CLAV DISLOC WO MANIP", "code_information": [ { "code": "23520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.94, "discounted_cash": 1586.0, "minimum": 90.282, "maximum": 300.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSULIN ANTIBODIES", "code_information": [ { "code": "86337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.63, "discounted_cash": 21.0, "minimum": 20.8062, "maximum": 349.3494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HFE GENE", "code_information": [ { "code": "81256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.69, "discounted_cash": 65.0, "minimum": 63.5168, "maximum": 365.9697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.39, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.52, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 110.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1902) AFO ANKLE GAUNTLET PRE OTS", "code_information": [ { "code": "L1902", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 105.0, "minimum": 102.6804, "maximum": 178.6922, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.35, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.68, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 178.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH", "code_information": [ { "code": "83521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.13, "discounted_cash": 17.0, "minimum": 16.783, "maximum": 103.0094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF GASTRIN", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.31, "discounted_cash": 17.0, "minimum": 17.1328, "maximum": 165.9503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.13, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 104.38, "10th_percentile": 104.38, "90th_percentile": 104.38, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dicyclomine HCl Inj 10 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "70069044101", "type": "NDC" }, { "code": "J0500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 27.649, "maximum": 27.649, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.65 } ] } ] }, { "description": "HC PERQ LUMBOSACRAL INJ", "code_information": [ { "code": "22511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16164.4, "discounted_cash": 3228.0, "minimum": 3228.48, "maximum": 15450.5367, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12718.92, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15450.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12360.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY FOOT 2 VW", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 342.81, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 342.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 342.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 201.15, "10th_percentile": 201.15, "90th_percentile": 201.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRA PELVIS W CONTRAST - C8918 - 61800007", "code_information": [ { "code": "C8918", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2630.0, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2293.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE", "code_information": [ { "code": "78099", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 975.0, "discounted_cash": 394.0, "minimum": 292.5, "maximum": 975.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 975.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 975.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 975.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13837.0, "minimum": 12028.58, "maximum": 39230.9772, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30386.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32890.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13837.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12028.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13837.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32890.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13837.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18702.22 } ] } ] }, { "description": "HC DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS", "code_information": [ { "code": "80306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.69, "discounted_cash": 17.0, "minimum": 16.6567, "maximum": 174.1297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.82, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.99, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PCA3/KLK3 PROSTATE SPECIFIC ANTIGEN RATIO", "code_information": [ { "code": "81313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1597.81, "discounted_cash": 255.0, "minimum": 247.8576, "maximum": 1393.2903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.86, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1338.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 431.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT NON-TUNNEL CV CATH =>5 YR", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3466.56, "discounted_cash": 3115.0, "minimum": 1039.968, "maximum": 3466.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3466.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3466.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3466.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3466.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1759) CATH, INTRA ECHOCARDIOGRAPHY", "code_information": [ { "code": "C1759", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1172.14, "10th_percentile": 1172.14, "90th_percentile": 2793.0, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY RETROGRADE PYELOGRAM", "code_information": [ { "code": "74420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1925.0, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1678.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 976.25, "10th_percentile": 976.25, "90th_percentile": 976.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 473.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1113.68, "10th_percentile": 1113.68, "90th_percentile": 1180.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN CERV SPINE CONTRAST", "code_information": [ { "code": "72126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3257.5, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2840.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1017.93 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT", "code_information": [ { "code": "005", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 79463.0, "minimum": 73708.01, "maximum": 233541.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 186309.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 233540.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 79463.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73708.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 79463.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 233541.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 79463.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 114670.08 } ] } ] }, { "description": "HC ASSAY OF TOTAL THYROXINE", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.06, "discounted_cash": 6.0, "minimum": 6.6763, "maximum": 116.9003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 85.8, "10th_percentile": 85.8, "90th_percentile": 85.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 68.32, "10th_percentile": 68.32, "90th_percentile": 68.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 73.53, "10th_percentile": 73.53, "90th_percentile": 73.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 30.71, "10th_percentile": 30.71, "90th_percentile": 30.71, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 94.38, "10th_percentile": 94.38, "90th_percentile": 94.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.62, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTERROGATION EVAL F2F 1/DUAL/MLT LEADS CVDFB", "code_information": [ { "code": "93289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.69, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 243.8897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TUBE THORACOSTOMY W DRAIN SYS", "code_information": [ { "code": "32551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1889.69, "discounted_cash": 1553.0, "minimum": 566.907, "maximum": 1889.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1889.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1889.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1889.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1889.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EEG,COMA/SLEEP RECORD ONLY", "code_information": [ { "code": "95822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1484.69, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1294.6497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ RADIOFREQ ABLATE LIVER TUMOR =>1", "code_information": [ { "code": "47382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23721.9, "discounted_cash": 5965.0, "minimum": 5965.14, "maximum": 23721.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23500.27, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23721.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22838.73, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6502.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10088.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROTEIN E-PHORESIS, SERUM", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.88, "discounted_cash": 10.0, "minimum": 10.4371, "maximum": 250.1594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 154.22, "10th_percentile": 146.83, "90th_percentile": 183.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 146.19, "10th_percentile": 146.19, "90th_percentile": 146.19, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 154.38, "10th_percentile": 146.99, "90th_percentile": 157.35, "count": "24" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 48.01, "10th_percentile": 48.01, "90th_percentile": 48.01, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 200.12, "10th_percentile": 56.35, "90th_percentile": 201.96, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6977.0, "minimum": 5400.71, "maximum": 20179.9892, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 18166.62, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9122.63, "10th_percentile": 9122.63, "90th_percentile": 20978.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14087.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 17171.5, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8710.7, "10th_percentile": 8710.7, "90th_percentile": 8710.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 17650.55, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7477.25, "10th_percentile": 7477.25, "90th_percentile": 23030.52, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12781.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5400.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12781.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 20179.99, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15526.86, "10th_percentile": 15526.86, "90th_percentile": 15526.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8670.46 } ] } ] }, { "description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [ { "code": "175", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11494.0, "minimum": 9752.85, "maximum": 34748.0019, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 31281.17, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16149.72, "10th_percentile": 16149.72, "90th_percentile": 16149.72, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24820.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20202.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11494.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9752.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11494.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20202.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11494.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15276.74 } ] } ] }, { "description": "HC PARVOVIRUS", "code_information": [ { "code": "86747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 507.19, "discounted_cash": 15.0, "minimum": 14.6062, "maximum": 442.2697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Magnesium Sulfate in Dextrose 5% IV Soln 1 GM/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338170940", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0535, "maximum": 1.0535, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 72.46, "10th_percentile": 72.46, "90th_percentile": 144.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 80.49, "10th_percentile": 80.49, "90th_percentile": 80.49, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL C9363) SKIN SUB INTEGRA BILAYER PER SQ CM", "code_information": [ { "code": "C9363", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11002.0, "minimum": 8713.26, "maximum": 24568.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23649.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24568.65 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8713.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24568.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14556.05 } ] } ] }, { "description": "HC (SUP SHELL L4396) STATIC OR DYNAMI AFO PRE CST", "code_information": [ { "code": "L4396", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 210.0, "minimum": 204.3501, "maximum": 355.6255, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 255.43, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 204.35, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 355.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ceftazidime For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "25021012720", "type": "NDC" }, { "code": "J0713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.44, "maximum": 3.44, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.44 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5739.0, "minimum": 4319.6, "maximum": 52203.1607, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11147.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10797.74 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5739.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4319.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5739.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10797.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5739.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6860.96 } ] } ] }, { "description": "HC X-RAY TOE(S)", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 370.0, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 370.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 223.4, "10th_percentile": 223.4, "90th_percentile": 223.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 370.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 177.04, "10th_percentile": 177.04, "90th_percentile": 177.04, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 225.76, "10th_percentile": 225.76, "90th_percentile": 225.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 201.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 258.11, "10th_percentile": 258.11, "90th_percentile": 258.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRLML BLLN ANGIOP OPEN/PERQ W/IMG S&I INIT VEIN", "code_information": [ { "code": "37248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18979.4, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 18979.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18979.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18979.4, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18979.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13123.0, "minimum": 10735.67, "maximum": 47523.1629, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28689.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27458.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13123.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10735.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13123.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27458.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13123.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17657.89 } ] } ] }, { "description": "NEUROLOGICAL EYE DISORDERS", "code_information": [ { "code": "123", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7121.0, "minimum": 5559.21, "maximum": 37875.395, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14430.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14382.7 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 37788.52, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13943.11, "10th_percentile": 13943.11, "90th_percentile": 13943.11, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7121.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5559.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7121.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14382.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7121.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8881.77 } ] } ] }, { "description": "HC ASSAY OF CALCIUM, TOTAL", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.25, "discounted_cash": 5.0, "minimum": 5.0145, "maximum": 31.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.2, "10th_percentile": 19.49, "90th_percentile": 23.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.27, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.01, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 18.47, "10th_percentile": 18.47, "90th_percentile": 36.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 19.88, "10th_percentile": 19.51, "90th_percentile": 19.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.07, "10th_percentile": 23.07, "90th_percentile": 23.07, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 25.52, "10th_percentile": 25.52, "90th_percentile": 25.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TARSAL FX WO MANIP EA", "code_information": [ { "code": "28450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC STRAPPING ELBOW OR WRIST", "code_information": [ { "code": "29260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.69, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 278.7697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "905", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 11407.74, "maximum": 32081.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26804.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32081.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12329.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11407.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12329.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32081.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12329.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16497.9 } ] } ] }, { "description": "HC X-RAY THORACIC SPINE 2 VW", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 608.44, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 530.5597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 367.4, "10th_percentile": 367.4, "90th_percentile": 367.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 291.16, "10th_percentile": 291.16, "90th_percentile": 308.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 357.02, "10th_percentile": 357.02, "90th_percentile": 371.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 92.04, "10th_percentile": 92.04, "90th_percentile": 92.04, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 424.45, "10th_percentile": 424.45, "90th_percentile": 424.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC", "code_information": [ { "code": "058", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14049.0, "minimum": 12776.08, "maximum": 51748.1, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51748.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12776.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51748.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19012.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30890.39 } ] } ] }, { "description": "HC REMOVAL OF NAIL PLATE", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.13, "discounted_cash": 197.0, "minimum": 110.439, "maximum": 368.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 368.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 368.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 368.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine Inj 2% w/ Epinephrine-1:100000", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409014701", "type": "NDC" }, { "code": "J2004", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.84, "90th_percentile": 14.84, "count": "1 through 10" } ] } ] }, { "description": "HC CONTINUOUS INHALATION TX, 1ST HR", "code_information": [ { "code": "94644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.31, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 525.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 525.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [ { "code": "651", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29232.0, "minimum": 24034.32, "maximum": 322430.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 66963.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 322429.95 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 29232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24034.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 322430.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 29232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41214.72 } ] } ] }, { "description": "HC (SUP SHELL Q4170) CYGNUS, PER SQ CM", "code_information": [ { "code": "Q4170", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 956.191, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 956.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MUMPS", "code_information": [ { "code": "86735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.94, "discounted_cash": 13.0, "minimum": 12.682, "maximum": 88.0197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.33, "10th_percentile": 58.33, "90th_percentile": 58.33, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 51.44, "10th_percentile": 51.44, "90th_percentile": 51.44, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 52.28, "10th_percentile": 52.28, "90th_percentile": 52.28, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 58.33, "10th_percentile": 58.33, "90th_percentile": 58.33, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 67.1, "10th_percentile": 67.1, "90th_percentile": 70.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT UPPER EXTREMITY WO/W CONTRAST", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2008.13, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1751.0894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1743.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITH CC", "code_information": [ { "code": "184", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9140.0, "minimum": 7392.67, "maximum": 19228.1167, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19228.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16716.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9140.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7392.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9140.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16716.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 17429.31, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7202.56, "10th_percentile": 7202.56, "90th_percentile": 7202.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9140.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11834.58 } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC", "code_information": [ { "code": "421", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14262.0, "minimum": 11334.37, "maximum": 49911.8857, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31396.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46896.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14262.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11334.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14262.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46896.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14262.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19323.92 } ] } ] }, { "description": "HC SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC", "code_information": [ { "code": "62270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 948.44, "discounted_cash": 696.0, "minimum": 284.532, "maximum": 948.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 948.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 948.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 948.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 719.85, "10th_percentile": 719.85, "90th_percentile": 719.85, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 948.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1726) CATHETER BALLOON DILAT NON-VASCULAR", "code_information": [ { "code": "C1726", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 829.82, "10th_percentile": 829.82, "90th_percentile": 1580.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 834.06, "10th_percentile": 764.11, "90th_percentile": 834.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 834.06, "10th_percentile": 834.06, "90th_percentile": 948.74, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL C1788) PORT INDWELLING", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1339.2, "10th_percentile": 1339.2, "90th_percentile": 1339.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1366.19, "10th_percentile": 1366.19, "90th_percentile": 1366.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1373.17, "10th_percentile": 1195.13, "90th_percentile": 1373.17, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1406.13, "10th_percentile": 1406.13, "90th_percentile": 1406.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1373.17, "10th_percentile": 1371.92, "90th_percentile": 1473.12, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAYS, BONE SURVEY, INFANT", "code_information": [ { "code": "77076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 344.38, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 344.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 344.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 344.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 344.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND CPLX EYE/EAR/NOSE/LIP 2.6-7.5 CM", "code_information": [ { "code": "13152", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2362.81, "discounted_cash": 729.0, "minimum": 708.843, "maximum": 2362.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CRYOPRECIPITATE POOLED PRODUCT", "code_information": [ { "code": "P9012", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2342.19, "discounted_cash": 71.0, "minimum": 71.6, "maximum": 2042.3897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 282.08, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 342.66, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 274.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROTEIN TOT XCPT REFRACTOMETRY URINE", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.25, "discounted_cash": 3.0, "minimum": 3.5665, "maximum": 88.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.4, "10th_percentile": 43.18, "90th_percentile": 51.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 31.85, "10th_percentile": 31.85, "90th_percentile": 51.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 34.28, "10th_percentile": 34.28, "90th_percentile": 55.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 16.4, "10th_percentile": 16.4, "90th_percentile": 16.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 70.63, "10th_percentile": 44.0, "90th_percentile": 71.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51055.0, "minimum": 41177.07, "maximum": 142202.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 118814.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 142202.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41177.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 142202.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 73128.38 } ] } ] }, { "description": "HC (SUP SHELL A4222) INFUSION SUPPLIES WITH PUMP", "code_information": [ { "code": "A4222", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 49.0, "minimum": 47.6862, "maximum": 82.9872, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.61, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 47.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.99, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L4386) NON-PNEUM WALK BOOT PRE CST", "code_information": [ { "code": "L4386", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 190.0, "minimum": 184.7975, "maximum": 321.5986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 230.99, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 184.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 207.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 321.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8610) OCULAR IMPLANT", "code_information": [ { "code": "L8610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 716.0, "minimum": 696.3627, "maximum": 1211.8632, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 870.42, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 696.36, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 781.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1211.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [ { "code": "065", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8731.0, "minimum": 7038.3, "maximum": 26324.3495, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 23697.95, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11602.12, "10th_percentile": 11602.12, "90th_percentile": 17540.33, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8420.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18255.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8420.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 23097.2, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 27073.81, "10th_percentile": 27073.81, "90th_percentile": 27073.81, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8420.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23122.98 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 26263.97, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15756.33, "10th_percentile": 15756.33, "90th_percentile": 15756.33, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8731.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7038.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8731.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23123.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8420.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8731.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8420.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11236.23 } ] } ] }, { "description": "HC HEART/LUNG RESUSCITATION (CPR)", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1464.38, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1276.9394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6457) TUBULAR DRESSING - A6457 - RU272066", "code_information": [ { "code": "A6457", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.5743, "maximum": 2.7397, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.57, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.74, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6448) LT COMPRES BAND <3/YD - A6448 - 27100024", "code_information": [ { "code": "A6448", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.5938, "maximum": 2.7736, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.59, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF GLUCAGON", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.88, "discounted_cash": 14.0, "minimum": 13.887, "maximum": 215.2794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 63.88, "10th_percentile": 63.88, "90th_percentile": 63.88, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.89, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC", "code_information": [ { "code": "424", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17687.0, "minimum": 15803.47, "maximum": 48032.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17014.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39535.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17014.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17014.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48032.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17687.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15803.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17687.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48032.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17014.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17687.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17014.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24333.12 } ] } ] }, { "description": "HC ARC BLOOD TYPING, RH (D)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.81, "discounted_cash": 36.0, "minimum": 15.6891, "maximum": 57.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 31.08, "10th_percentile": 31.08, "90th_percentile": 37.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 13.37, "10th_percentile": 13.37, "90th_percentile": 13.37, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Magnesium Sulfate IV Soln 20 GM/500ML (40 MG/ML)", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00409205001", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0535, "maximum": 1.0535, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 72.46, "10th_percentile": 72.46, "90th_percentile": 144.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 80.49, "10th_percentile": 80.49, "90th_percentile": 80.49, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6449) LT COMPRES BAND >=3 <5/YD - A6449 - 27090039", "code_information": [ { "code": "A6449", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4295, "maximum": 4.228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (PF) Inj 100 MCG/2ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409909412", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.806, "maximum": 1.806, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 28.54, "count": "52" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.81 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 4.45, "90th_percentile": 29.69, "count": "19" } ] } ] }, { "description": "HC (SUP SHELL Q4134) HMATRIX", "code_information": [ { "code": "Q4134", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TUMOR IMAGING, LIMITED AREA", "code_information": [ { "code": "78800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1966.25, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1887.7194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1553.98, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1887.72, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1772.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF FETAL FIBRONECTIN", "code_information": [ { "code": "82731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1165.0, "discounted_cash": 64.0, "minimum": 62.5936, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.24, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.59, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 337.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 337.97, "10th_percentile": 337.97, "90th_percentile": 337.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT", "code_information": [ { "code": "62329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3506.56, "discounted_cash": 696.0, "minimum": 696.49, "maximum": 3333.1922, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN", "code_information": [ { "code": "49900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34281.6, "minimum": 10284.48, "maximum": 29893.5552, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16804.48 } ] } ] }, { "description": "HC X-RAY EXAM SELLA", "code_information": [ { "code": "70240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 526.56, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 459.1603, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "HC QUANTITATIVE ASSAY, DRUG", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.31, "discounted_cash": 18.0, "minimum": 18.1144, "maximum": 331.6303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 192.86, "10th_percentile": 192.86, "90th_percentile": 192.86, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 167.25, "10th_percentile": 167.25, "90th_percentile": 173.97, "count": "17" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 265.3, "10th_percentile": 265.3, "90th_percentile": 265.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SMEAR, FLUOR STAIN, W INTERP", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.38, "discounted_cash": 5.0, "minimum": 5.238, "maximum": 112.8194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.24, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM BONE IMAGING, 3 PHASE", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1769.06, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1769.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1553.98, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1769.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1769.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NUCLEAR THERAPY, MONOCLONAL AB", "code_information": [ { "code": "79403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3777.81, "discounted_cash": 230.0, "minimum": 230.23, "maximum": 3294.2503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 907.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1101.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 881.48, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 886.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 389.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CANDIDA DNA DIR PROBE", "code_information": [ { "code": "87480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.88, "discounted_cash": 20.0, "minimum": 19.4846, "maximum": 81.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 49.4, "10th_percentile": 41.5, "90th_percentile": 49.4, "count": "34" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.48, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 41.72, "10th_percentile": 41.72, "90th_percentile": 41.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 42.34, "10th_percentile": 42.34, "90th_percentile": 44.06, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 65.5, "10th_percentile": 49.4, "90th_percentile": 65.5, "count": "18" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 57.11, "10th_percentile": 57.11, "90th_percentile": 57.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEPATITIS C VIRUS, GENOTYPE ANAL DNA/RNA", "code_information": [ { "code": "87902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3254.06, "discounted_cash": 257.0, "minimum": 250.1899, "maximum": 2837.5403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1150.8, "10th_percentile": 1150.8, "90th_percentile": 1150.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 312.72, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 250.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 1683.83, "10th_percentile": 1683.83, "90th_percentile": 1683.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1350.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2270.03, "10th_percentile": 2270.03, "90th_percentile": 2270.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 435.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14972.0, "minimum": 12621.74, "maximum": 36864.3399, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33082.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28328.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14972.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12621.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14972.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28329.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14972.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20361.57 } ] } ] }, { "description": "HC MRI JOINT OF LEG W/CONTRAST", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3321.88, "discounted_cash": 773.0, "minimum": 773.49, "maximum": 3321.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3047.24, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3321.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2961.46, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2164.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dopamine in Dextrose 5% Inj 3.2 MG/ML", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "00338100902", "type": "NDC" }, { "code": "J1265", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.5265, "maximum": 1.5265, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.53 } ] } ] }, { "description": "HC INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC", "code_information": [ { "code": "20500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2700.94, "discounted_cash": 1530.0, "minimum": 810.282, "maximum": 2700.94, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2589.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2700.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2700.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2700.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "755", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9321.0, "minimum": 7683.37, "maximum": 94632.3612, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19656.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18020.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9321.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7683.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9321.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18020.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9321.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12098.16 } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32905.0, "minimum": 28461.2, "maximum": 102029.7116, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 91850.14, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 28478.34, "10th_percentile": 28478.34, "90th_percentile": 28478.34, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31616.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75690.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31616.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31616.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 91338.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32905.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28461.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32905.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 91338.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31616.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 32905.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31616.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46586.49 } ] } ] }, { "description": "HC CT SCAN LUMBAR SPINE WO/W CONTRAST", "code_information": [ { "code": "72133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.94, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2211.3397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1260.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "816", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5854.0, "minimum": 4563.93, "maximum": 19715.1003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5660.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11420.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5660.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5660.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10392.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5854.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4563.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5854.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10392.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5660.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5854.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5660.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7028.9 } ] } ] }, { "description": "HC (SUP SHELL L2106) AFO TIB FX CAST PLASTER MOLD", "code_information": [ { "code": "L2106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1041.0, "minimum": 1012.3727, "maximum": 1761.8076, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1265.41, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1012.37, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1135.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1761.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine Inj 1% w/ Epinephrine-1:100000", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00409317818", "type": "NDC" }, { "code": "J2004", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.84, "90th_percentile": 14.84, "count": "1 through 10" } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "830", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12494.0, "minimum": 10122.45, "maximum": 41690.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27195.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41690.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12494.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10122.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12494.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41690.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12494.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16738.13 } ] } ] }, { "description": "HC ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3 - G0480 - 30100444", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 874.38, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ORBITAL IMPLANT REMOVAL/REVISION", "code_information": [ { "code": "67560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13121.3, "discounted_cash": 3879.0, "minimum": 3879.12, "maximum": 13121.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13121.3, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13121.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13121.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4228.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6560.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY THYROID STIM HORMONE", "code_information": [ { "code": "84443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.38, "discounted_cash": 16.0, "minimum": 16.3262, "maximum": 230.5394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 169.2, "10th_percentile": 142.13, "90th_percentile": 169.2, "count": "176" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.41, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 134.73, "10th_percentile": 134.73, "90th_percentile": 161.37, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 145.0, "10th_percentile": 142.28, "90th_percentile": 145.0, "count": "281" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 75.1, "10th_percentile": 75.1, "90th_percentile": 169.2, "count": "80" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 184.43, "10th_percentile": 88.15, "90th_percentile": 186.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4238) DERM-MAXX, PER SQ CM", "code_information": [ { "code": "Q4238", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 3536.7285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3536.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY HAND 3+ VW", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 447.7197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 260.4, "10th_percentile": 114.3, "90th_percentile": 310.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 260.42, "10th_percentile": 260.42, "90th_percentile": 260.42, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 313.28, "10th_percentile": 301.24, "90th_percentile": 313.28, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 254.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 114.48, "10th_percentile": 114.48, "90th_percentile": 310.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 341.0, "10th_percentile": 314.88, "90th_percentile": 358.17, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC", "code_information": [ { "code": "736", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28233.0, "minimum": 27133.8, "maximum": 69865.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 64590.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 69865.76 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27253.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69865.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39754.45 } ] } ] }, { "description": "HC LEUKOCYTE (WBC) COUNT", "code_information": [ { "code": "85048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.5, "discounted_cash": 2.0, "minimum": 2.4684, "maximum": 63.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 48.18, "10th_percentile": 48.18, "90th_percentile": 50.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4402) LUBRICANT PER OUNCE", "code_information": [ { "code": "A4402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.206, "maximum": 3.839, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.76, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.21, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Nalbuphine HCl Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409146371", "type": "NDC" }, { "code": "J2300", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.622, "maximum": 6.622, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.62 } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24944.0, "minimum": 19417.79, "maximum": 67952.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23978.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 56777.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23978.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23978.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 67952.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19417.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67952.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23978.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23978.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34945.43 } ] } ] }, { "description": "HC ASSAY OF PREGNENOLONE", "code_information": [ { "code": "84140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.88, "discounted_cash": 20.0, "minimum": 20.0871, "maximum": 106.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 85.5, "10th_percentile": 85.5, "90th_percentile": 85.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.11, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEG PRESS WOUND TX W DME, 16 <=48 SQ IN - A6197 - 27200112", "code_information": [ { "code": "A6197", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "minimum": 22.779, "maximum": 39.6417, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL TUNNELED INTRAPERITONEAL CATHETER", "code_information": [ { "code": "49422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11803.1, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 11803.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11803.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11803.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11803.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SPLENIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "801", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15565.0, "minimum": 11362.75, "maximum": 41283.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34493.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41283.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15565.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11362.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15565.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41283.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15565.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21230.17 } ] } ] }, { "description": "HC SCREENING DIGITAL BREAST TOMOSYNTHESIS BILAT", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 593.13, "discounted_cash": 21.0, "minimum": 20.9034, "maximum": 517.2094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 379.6, "10th_percentile": 379.6, "90th_percentile": 379.6, "count": "173" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.13, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 24.9, "10th_percentile": 24.9, "90th_percentile": 24.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.9, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 300.83, "10th_percentile": 300.83, "90th_percentile": 417.56, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 368.88, "10th_percentile": 361.9, "90th_percentile": 368.88, "count": "267" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 95.03, "10th_percentile": 95.03, "90th_percentile": 379.6, "count": "79" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 38.71, "10th_percentile": 38.71, "90th_percentile": 417.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TESTOSTERONE", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 447.19, "discounted_cash": 25.0, "minimum": 24.7517, "maximum": 389.9497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.94, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.75, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT SHLDR DISLOC,PROX HUM FX W MANIP", "code_information": [ { "code": "23675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 852.81, "discounted_cash": 1586.0, "minimum": 255.843, "maximum": 852.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "856", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35642.0, "minimum": 31226.27, "maximum": 92587.1881, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34243.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 82194.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34243.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34243.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 65460.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35642.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31226.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35642.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65460.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34243.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 35642.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34243.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50589.19 } ] } ] }, { "description": "HC REMOVAL FOREIGN BODY DEEP THIGH/KNEE", "code_information": [ { "code": "27372", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8870.63, "discounted_cash": 2866.0, "minimum": 2661.189, "maximum": 8870.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8870.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8870.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8870.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4847.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CCMCC", "code_information": [ { "code": "084", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8317.0, "minimum": 6617.48, "maximum": 21746.651, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8023.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17271.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8023.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8023.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19588.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8317.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6617.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8317.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19588.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8023.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8317.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8023.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10630.1 } ] } ] }, { "description": "Acetylcysteine Inj 200 MG/ML", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "63323096321", "type": "NDC" }, { "code": "J0132", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CLSD TREAT TRIMALLEOLAR FX WO MANIP", "code_information": [ { "code": "27816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 494.38, "discounted_cash": 243.0, "minimum": 148.314, "maximum": 494.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 494.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 494.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 494.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KCl 20 MEQ/L (0.15%) in NaCl 0.45% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338070434", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.06, "discounted_cash": 168.0, "minimum": 10.218, "maximum": 34.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ", "code_information": [ { "code": "76886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 510.94, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 510.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 308.4, "10th_percentile": 308.4, "90th_percentile": 308.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 299.69, "10th_percentile": 299.69, "90th_percentile": 299.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 510.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 275.53, "10th_percentile": 275.53, "90th_percentile": 275.53, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 339.24, "10th_percentile": 339.24, "90th_percentile": 356.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TEMPOROMANDBLE JT ARTHROGRAPHY RS&I", "code_information": [ { "code": "70332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1396.25, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1217.53, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 503.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "HC CANNABINOIDS NATURAL ASSAY - 80349 - 30100418", "code_information": [ { "code": "80349", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.69, "minimum": 70.4174, "maximum": 374.6897, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.42 } ] } ] }, { "description": "HC STREP A ASSAY W/OPTIC", "code_information": [ { "code": "87880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.5, "discounted_cash": 16.0, "minimum": 16.0639, "maximum": 111.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 77.0, "10th_percentile": 64.68, "90th_percentile": 77.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.08, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 65.99, "10th_percentile": 65.99, "90th_percentile": 65.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 73.89, "10th_percentile": 73.89, "90th_percentile": 73.89, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 84.7, "10th_percentile": 84.7, "90th_percentile": 88.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BETA-2 PROTEIN", "code_information": [ { "code": "82232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.19, "discounted_cash": 16.0, "minimum": 15.7237, "maximum": 232.9897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 143.64, "10th_percentile": 143.64, "90th_percentile": 171.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATHETERIZE FOR URINE SPEC", "code_information": [ { "code": "P9612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.38, "discounted_cash": 9.0, "minimum": 4.314, "maximum": 14.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0140) CERVICAL SEMI-RIGID ADJUSTAB", "code_information": [ { "code": "L0140", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 95.0, "minimum": 92.4182, "maximum": 160.8331, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.52, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.42, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dextrose 5% w/ Sodium Chloride 0.9%", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00338008903", "type": "NDC" }, { "code": "J7042", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.6875, "maximum": 2.6875, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.69 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "205", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14973.0, "minimum": 13066.09, "maximum": 36046.5836, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14410.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33085.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14410.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14410.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20656.37 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14973.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13066.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14973.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20656.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14410.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14973.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14410.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20363.8 } ] } ] }, { "description": "HC IMMUNFIX E-PHORSIS/URINE/CSF", "code_information": [ { "code": "86335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.19, "discounted_cash": 29.0, "minimum": 28.5223, "maximum": 237.3497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, LUMBAR SPINE COMBO", "code_information": [ { "code": "72158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3257.5, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2840.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1751.23, "10th_percentile": 1751.23, "90th_percentile": 1751.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1987.6, "10th_percentile": 1987.6, "90th_percentile": 2025.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1939.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2272.43, "10th_percentile": 2272.43, "90th_percentile": 2272.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CANALITH REPOSITIONING PER DAY", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.94, "discounted_cash": 29.0, "minimum": 28.2794, "maximum": 149.0597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.35, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.28, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 108.31, "10th_percentile": 108.31, "90th_percentile": 108.31, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30664.0, "minimum": 29466.9, "maximum": 84219.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 70367.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 29466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 29466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 84219.24 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 30664.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29947.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30664.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 84219.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 30664.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43310.05 } ] } ] }, { "description": "HC (SUP SHELL A6234) HYDROCOLLD DRG <=16 W/O BDR - A6234 - 27200131", "code_information": [ { "code": "A6234", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 9.0669, "maximum": 15.7789, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM BRAIN IMAGING < 4 STATIC VIEWS", "code_information": [ { "code": "78600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.19, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1752.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1553.98, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1752.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1298.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4150) ALLOWRAP DS OR DRY 1 SQ CM", "code_information": [ { "code": "Q4150", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.93 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OT THR ACTIVITY OTA COMPLEX EA 1 ", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 209.38, "discounted_cash": 33.0, "minimum": 32.3998, "maximum": 182.5794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 217.73, "10th_percentile": 217.73, "90th_percentile": 217.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF LITHIUM", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.13, "discounted_cash": 6.0, "minimum": 6.4236, "maximum": 116.0894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 80.4, "10th_percentile": 80.4, "90th_percentile": 80.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.42, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 67.84, "10th_percentile": 67.84, "90th_percentile": 67.84, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 68.9, "10th_percentile": 68.9, "90th_percentile": 68.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 29.55, "10th_percentile": 29.55, "90th_percentile": 29.55, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 34.68, "10th_percentile": 34.68, "90th_percentile": 34.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC B CELLS, TOTAL COUNT", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.75, "discounted_cash": 37.0, "minimum": 36.666, "maximum": 208.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 166.55, "10th_percentile": 166.55, "90th_percentile": 166.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSJ PERQ VAD W/RS&I R HEART VENOUS ACCESS ONLY", "code_information": [ { "code": "33995", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2071.56, "minimum": 621.468, "maximum": 2071.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2071.56 } ] } ] }, { "description": "HC REVSC EVASC IVT ANGIOP UNI SF LES 1ST VSL", "code_information": [ { "code": "37254", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27547.8, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 26875.9169, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22124.32, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26875.92, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVE NASAL FB", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322.19, "discounted_cash": 131.0, "minimum": 96.657, "maximum": 322.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 322.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 322.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 322.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CSF FLUID SCAN CISTERNOGRAPHY", "code_information": [ { "code": "78630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1283.75, "discounted_cash": 535.0, "minimum": 385.125, "maximum": 1283.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1283.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1283.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1283.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1283.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16002.0, "minimum": 12831.45, "maximum": 35530.7264, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35530.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21700.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16002.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12831.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16002.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21700.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16002.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21868.56 } ] } ] }, { "description": "HC GIARDIA AG EIA", "code_information": [ { "code": "87329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.94, "discounted_cash": 11.0, "minimum": 11.6422, "maximum": 144.6997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 53.55, "10th_percentile": 53.55, "90th_percentile": 53.55, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NUCLEAR ANTIGEN ANTIBODY", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.63, "discounted_cash": 17.0, "minimum": 17.4244, "maximum": 161.8694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 278.04, "10th_percentile": 112.0, "90th_percentile": 736.18, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 267.54, "10th_percentile": 189.19, "90th_percentile": 267.54, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 287.95, "10th_percentile": 175.17, "90th_percentile": 299.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 369.6, "10th_percentile": 224.84, "90th_percentile": 641.36, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TRIGLYCERIDES", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.69, "discounted_cash": 5.0, "minimum": 5.5781, "maximum": 134.8897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 83.16, "10th_percentile": 83.16, "90th_percentile": 99.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 78.83, "10th_percentile": 78.83, "90th_percentile": 78.83, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 83.25, "10th_percentile": 83.25, "90th_percentile": 84.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 108.9, "10th_percentile": 108.9, "90th_percentile": 108.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4349) DISPOSABLE MALE EXTERNAL CAT", "code_information": [ { "code": "A4349", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.7891, "maximum": 4.8537, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.49, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Meropenem IV For Soln 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55150020720", "type": "NDC" }, { "code": "J2185", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC", "code_information": [ { "code": "650", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36803.0, "minimum": 31888.64, "maximum": 84953.5458, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35357.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 84953.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 35357.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35357.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43344.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31888.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43344.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35357.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 36803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35357.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52287.47 } ] } ] }, { "description": "HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN S&I", "code_information": [ { "code": "37619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15691.9, "discounted_cash": 5490.0, "minimum": 4707.57, "maximum": 15691.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15691.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15691.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15691.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ", "code_information": [ { "code": "78227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1631.25, "discounted_cash": 535.0, "minimum": 489.375, "maximum": 1631.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 876.96, "10th_percentile": 876.96, "90th_percentile": 876.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1631.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1631.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1631.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1631.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 625.15, "10th_percentile": 625.15, "90th_percentile": 625.15, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM", "code_information": [ { "code": "42160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12218.4, "discounted_cash": 3271.0, "minimum": 3271.37, "maximum": 12218.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12218.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12218.4, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12218.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3565.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5532.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LEFT HEART CATH INJ VETRICULOGRAPHY, RS/I", "code_information": [ { "code": "93452", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PHENYTOIN, TOTAL", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.69, "discounted_cash": 13.0, "minimum": 12.8764, "maximum": 174.1297, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 59.23, "10th_percentile": 59.23, "90th_percentile": 59.23, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HC QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING", "code_information": [ { "code": "78597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 891.56, "discounted_cash": 394.0, "minimum": 267.468, "maximum": 891.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 891.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 891.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 891.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 891.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6450) LT COMPRES BAND >=5/YD - A6450 - 27100026", "code_information": [ { "code": "A6450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4295, "maximum": 4.228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL OF SKIN TAGS, UP TO 15", "code_information": [ { "code": "11200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.44, "discounted_cash": 197.0, "minimum": 70.032, "maximum": 233.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 233.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 233.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 233.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 233.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4357) BEDSIDE DRAINAGE BAG", "code_information": [ { "code": "A4357", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 11.0, "minimum": 11.4284, "maximum": 19.8885, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FUNGUS ISOLATION CULTURE", "code_information": [ { "code": "87102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.94, "discounted_cash": 8.0, "minimum": 8.1728, "maximum": 183.9397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 37.59, "10th_percentile": 37.59, "90th_percentile": 37.59, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 73.89, "10th_percentile": 73.89, "90th_percentile": 107.49, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 75.07, "10th_percentile": 75.07, "90th_percentile": 113.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 37.59, "10th_percentile": 37.59, "90th_percentile": 37.59, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6456) ZINC PASTE BAND W >=3<5/YD - A6456 - 27100099", "code_information": [ { "code": "A6456", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.7395, "maximum": 3.0272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.74, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BONE BX TR/NDL; SUPERF", "code_information": [ { "code": "20220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4501.25, "discounted_cash": 1629.0, "minimum": 1350.375, "maximum": 4501.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1016.38, "10th_percentile": 1016.38, "90th_percentile": 1016.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4501.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4501.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4501.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5120) SKIN BARRIER, WIPE OR SWAB", "code_information": [ { "code": "A5120", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC", "code_information": [ { "code": "579", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25678.0, "minimum": 22559.38, "maximum": 97806.184, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58519.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38906.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25678.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22559.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25678.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38906.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25678.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36017.56 } ] } ] }, { "description": "HC CYTOMEG, DNA, AMP PROBE", "code_information": [ { "code": "87496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 491.25, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 428.37, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 180.79, "10th_percentile": 180.79, "90th_percentile": 180.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 184.12, "10th_percentile": 184.12, "90th_percentile": 184.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4407) EXT WEAR OST SKN BARR <=4SQ", "code_information": [ { "code": "A4407", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 12.0, "minimum": 12.1281, "maximum": 21.1062, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.16, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.13, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOPATH SMEAR OTHER SOURCE", "code_information": [ { "code": "88162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.69, "discounted_cash": 51.0, "minimum": 51.42, "maximum": 244.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 244.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 244.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA", "code_information": [ { "code": "78835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1122.19, "minimum": 336.657, "maximum": 978.5497, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 599.61 } ] } ] }, { "description": "HC ENDOVAS PLCMNT ILIAC ARTERY OCCLSN DVC", "code_information": [ { "code": "34808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13209.4, "minimum": 2944.0066, "maximum": 11518.5968, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2944.01 } ] } ] }, { "description": "HC EPSTEIN-BARR ANTIBODY,NUCLEAR", "code_information": [ { "code": "86664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.63, "discounted_cash": 15.0, "minimum": 14.8588, "maximum": 196.7494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 136.2, "10th_percentile": 136.2, "90th_percentile": 136.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 114.98, "10th_percentile": 114.98, "90th_percentile": 114.98, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 68.35, "10th_percentile": 68.35, "90th_percentile": 68.35, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 149.82, "10th_percentile": 80.23, "90th_percentile": 157.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BILIARY ENDOSCOPY PERCUT,DIL+STENT", "code_information": [ { "code": "47556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2937.81, "discounted_cash": 10488.0, "minimum": 881.343, "maximum": 2937.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SEPTIC ARTHRITIS WITH MCC", "code_information": [ { "code": "548", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15733.0, "minimum": 13943.71, "maximum": 41758.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34891.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41758.92 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15733.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13943.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15733.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41758.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15733.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21474.85 } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED MINIMAL PROBLEM(S) - 99211 - 76100006", "code_information": [ { "code": "99211", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.5, "minimum": 41.25, "maximum": 119.9, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 96.8, "10th_percentile": 96.8, "90th_percentile": 96.8, "count": "1 through 10" } ] } ] }, { "description": "HC HERPES SIMPLEX TEST, TYPE 1", "code_information": [ { "code": "86695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.06, "discounted_cash": 13.0, "minimum": 12.818, "maximum": 221.5403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 153.4, "10th_percentile": 153.4, "90th_percentile": 153.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 178.86, "10th_percentile": 178.86, "90th_percentile": 178.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7799.0, "minimum": 6215.35, "maximum": 18364.3287, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7526.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16040.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7526.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7526.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14503.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7799.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6215.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7799.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14503.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7526.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7799.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7526.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9872.72 } ] } ] }, { "description": "HC X-RAY LEG, INFANT", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 596.56, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 520.2003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DOPPLER CW/PW LIMITED (93321)", "code_information": [ { "code": "93321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 635.31, "minimum": 190.593, "maximum": 553.9903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 341.54, "10th_percentile": 341.54, "90th_percentile": 341.54, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 387.79, "10th_percentile": 387.79, "90th_percentile": 387.79, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 395.11, "10th_percentile": 387.64, "90th_percentile": 395.11, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 389.62, "10th_percentile": 389.62, "90th_percentile": 389.62, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 109.2, "10th_percentile": 109.2, "90th_percentile": 109.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 443.19, "10th_percentile": 443.19, "90th_percentile": 447.26, "count": "1 through 10" } ] } ] }, { "description": "Hyaluronidase Human Inj 150 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "18657011702", "type": "NDC" }, { "code": "J3473", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CLSD TREAT FEMUR SHAFT FX W MANIP", "code_information": [ { "code": "27502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5920.94, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 5920.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5920.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5920.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5920.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SUPRAPUBIC TUBE PLACEMENT AND ASPIRATION", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10440.9, "discounted_cash": 2062.0, "minimum": 2062.58, "maximum": 9870.8891, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8125.74, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9870.89, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7897.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [ { "code": "596", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9280.0, "minimum": 7482.65, "maximum": 19560.6018, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8947.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19560.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8947.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8947.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8227.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9280.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7482.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9280.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8227.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8947.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9280.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8947.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12039.22 } ] } ] }, { "description": "HC MRI BRAIN COMBO", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3143.44, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2741.0797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1689.91, "10th_percentile": 1689.91, "90th_percentile": 1689.91, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1954.97, "10th_percentile": 1918.0, "90th_percentile": 1954.97, "count": "18" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1933.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 852.97, "10th_percentile": 852.97, "90th_percentile": 852.97, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2192.86, "10th_percentile": 704.98, "90th_percentile": 2212.98, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7048) VACUUM DRAIN BOTTLE/TUBE KIT", "code_information": [ { "code": "A7048", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 58.0, "minimum": 57.2001, "maximum": 99.544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57.2, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NEUROSES EXCEPT DEPRESSIVE", "code_information": [ { "code": "882", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9214.0, "minimum": 6658.32, "maximum": 19403.3942, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19403.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11717.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9214.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6658.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9214.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11717.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9214.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11942.46 } ] } ] }, { "description": "HC ASSAY OF PROGESTERONE 17-D", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.31, "discounted_cash": 27.0, "minimum": 26.4038, "maximum": 240.0703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 121.45, "10th_percentile": 121.45, "90th_percentile": 121.45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 148.16, "10th_percentile": 148.16, "90th_percentile": 151.0, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 192.06, "10th_percentile": 192.06, "90th_percentile": 193.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHROMOTOGRAPHY, QUANT, SINGLE", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1084.38, "discounted_cash": 24.0, "minimum": 23.4107, "maximum": 945.5794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.41, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 126.41, "10th_percentile": 126.41, "90th_percentile": 126.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.74, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13567.0, "minimum": 11470.72, "maximum": 35869.6351, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29744.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 31373.59, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18190.7, "10th_percentile": 18190.7, "90th_percentile": 18190.7, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26006.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13567.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11470.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13567.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26006.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13567.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18307.4 } ] } ] }, { "description": "HC I&D BREAST LESION", "code_information": [ { "code": "19000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2984.06, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 2984.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1873.99, "10th_percentile": 1873.99, "90th_percentile": 1873.99, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2984.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPLANTATION THUMB COMPLETE", "code_information": [ { "code": "20827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5450.63, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 5450.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5450.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 5450.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5450.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19720.0, "minimum": 12749.78, "maximum": 44363.2642, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44363.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27682.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19720.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12749.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19720.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27682.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19720.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27304.84 } ] } ] }, { "description": "Sodium Chloride IV Soln 3%", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "63323053021", "type": "NDC" }, { "code": "J7131", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL Q4102) OASIS WOUND MATRIX PER SQ CM", "code_information": [ { "code": "Q4102", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 25.8215, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATHETER ASPIRATN NASOTRACH", "code_information": [ { "code": "31720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 855.31, "discounted_cash": 216.0, "minimum": 216.06, "maximum": 855.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 851.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 855.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 827.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 235.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 365.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS", "code_information": [ { "code": "876", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30442.0, "minimum": 27198.06, "maximum": 83619.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 69838.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 83619.14 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 30442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27198.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 83619.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 30442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42984.18 } ] } ] }, { "description": "HC TEST FOR CHLOROHYDROCARBONS", "code_information": [ { "code": "82441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.06, "discounted_cash": 6.0, "minimum": 5.8405, "maximum": 230.2603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TRAUMATIC HIP DISLOC WO ANES", "code_information": [ { "code": "27250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.75, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 878.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BIOPSY SALIVARY GLAND INCISIONAL", "code_information": [ { "code": "42405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4649.69, "discounted_cash": 1530.0, "minimum": 1394.907, "maximum": 4649.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4649.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4649.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4649.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2589.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRA LOWER EXTREM W CONTRAST - 73725 - 61600001", "code_information": [ { "code": "73725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4708.75, "minimum": 900.0, "maximum": 4106.03, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.23 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47156.0, "minimum": 42280.33, "maximum": 162929.7661, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 109550.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 45291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 131113.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 47156.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42280.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47156.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 131114.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 47156.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 67426.3 } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6115.0, "minimum": 4596.46, "maximum": 15212.2667, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12039.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9864.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4596.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9864.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7410.38 } ] } ] }, { "description": "HC BX BREAST W DEVICE MRI GUIDE 1ST LESION", "code_information": [ { "code": "19085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5855.63, "discounted_cash": 1629.0, "minimum": 900.0, "maximum": 5855.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5855.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5855.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5855.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ULTRASOUND,TRANSVAGINAL", "code_information": [ { "code": "76830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 718.13, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 718.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 364.22, "10th_percentile": 364.22, "90th_percentile": 364.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 500.96, "10th_percentile": 500.96, "90th_percentile": 500.96, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 421.35, "10th_percentile": 421.35, "90th_percentile": 438.17, "count": "24" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 718.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 335.88, "10th_percentile": 335.88, "90th_percentile": 353.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 476.96, "10th_percentile": 220.21, "90th_percentile": 500.96, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6450) LT COMPRES BAND >=5/YD - A6450 - 27090040", "code_information": [ { "code": "A6450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4295, "maximum": 4.228, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC HEART FIRST PASS ADD-ON", "code_information": [ { "code": "78496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1081.56, "minimum": 166.7621, "maximum": 943.1203, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.76 } ] } ] }, { "description": "VEIN LIGATION AND STRIPPING", "code_information": [ { "code": "263", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24300.0, "minimum": 18563.7, "maximum": 61505.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23360.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 55246.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23360.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23360.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 61505.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24300.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18563.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24300.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 61505.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23360.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24300.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23360.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34003.42 } ] } ] }, { "description": "HC INDUC ARRHYTH BY HEART RHYTHM PACING", "code_information": [ { "code": "93618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3523.13, "discounted_cash": 1201.0, "minimum": 1056.939, "maximum": 3523.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2031.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7002) TUBING USED W SUCTION PUMP", "code_information": [ { "code": "A7002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 5.1603, "maximum": 8.9803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7863.0, "minimum": 6348.24, "maximum": 22192.5776, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7588.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16194.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7588.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 19410.87, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16027.25, "10th_percentile": 16027.25, "90th_percentile": 16027.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 19471.95, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15550.85, "10th_percentile": 15550.85, "90th_percentile": 24636.21, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7588.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12005.71 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 22141.68, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 41618.83, "10th_percentile": 41618.83, "90th_percentile": 41618.83, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7863.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6348.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7863.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12005.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 22192.58, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 14181.71, "10th_percentile": 14181.71, "90th_percentile": 28639.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7588.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7863.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7588.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9967.25 } ] } ] }, { "description": "HC (SUP SHELL L4360) PNEUMAT WALKING BOOT PRE CST", "code_information": [ { "code": "L4360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 424.0, "minimum": 412.2764, "maximum": 717.4747, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 515.32, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 412.28, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 462.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 717.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4256) MLG COMPLET, PER SQ CM", "code_information": [ { "code": "Q4256", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 2010.293, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2010.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATH PLC/COR ANGIO RS/I BYPAS ANGIO W R HT CATH", "code_information": [ { "code": "93457", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL", "code_information": [ { "code": "37236", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39143.8, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 39143.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39143.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39143.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39143.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FRAGMENT KIDNEY STONE/ ESWL", "code_information": [ { "code": "50590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.0, "discounted_cash": 3478.0, "minimum": 52.5, "maximum": 175.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC GONADOTROPIN (LH)", "code_information": [ { "code": "83002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.75, "discounted_cash": 18.0, "minimum": 17.9977, "maximum": 251.79, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 201.43, "10th_percentile": 97.18, "90th_percentile": 203.28, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 184.8, "10th_percentile": 155.23, "90th_percentile": 184.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 147.15, "10th_percentile": 147.15, "90th_percentile": 147.15, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 155.39, "10th_percentile": 155.39, "90th_percentile": 158.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 46.62, "10th_percentile": 46.62, "90th_percentile": 82.78, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CHANGE PERCUT TUBE/DRAIN CATH W CONTRAST MONIT", "code_information": [ { "code": "75984", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1433.44, "minimum": 430.032, "maximum": 1249.9597, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 508.93 } ] } ] }, { "description": "HC CHEST X-RAY 1 VW", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.06, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 319.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 171.53, "10th_percentile": 68.08, "90th_percentile": 171.53, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 68.26, "10th_percentile": 68.26, "90th_percentile": 68.26, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 222.58, "10th_percentile": 222.58, "90th_percentile": 224.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD GASES: PH, PO2 & PCO2", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.81, "discounted_cash": 26.0, "minimum": 25.3348, "maximum": 325.0903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & INTERPJ", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1454.06, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1454.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1454.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 985.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIAGNOSTIC ANOSCOPY", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.81, "discounted_cash": 131.0, "minimum": 99.843, "maximum": 332.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 332.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 332.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 332.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SCAPULA", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 415.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 415.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 415.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 253.6, "10th_percentile": 253.6, "90th_percentile": 253.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 60.35, "10th_percentile": 60.35, "90th_percentile": 60.35, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF THEOPHYLLINE", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.81, "discounted_cash": 14.0, "minimum": 13.7413, "maximum": 168.1303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OCCUP THRP EVAL, MODERATE COMPLEXITY, 45 MIN", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 626.88, "discounted_cash": 96.0, "minimum": 93.7981, "maximum": 546.6394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 337.01, "10th_percentile": 337.01, "90th_percentile": 337.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 384.45, "10th_percentile": 384.45, "90th_percentile": 384.45, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "987", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27122.0, "minimum": 24243.34, "maximum": 78705.1395, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26067.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 61950.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26067.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26067.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 72870.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 27122.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24243.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27122.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 72870.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26067.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 27122.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26067.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38129.57 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7110.0, "minimum": 5283.05, "maximum": 17239.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6865.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14403.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6865.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6865.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17238.97 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7110.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5283.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7110.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17239.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6865.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7110.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6865.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8865.09 } ] } ] }, { "description": "HC VIRUS ID,INOC TEST,OBSERV", "code_information": [ { "code": "87252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.06, "discounted_cash": 26.0, "minimum": 25.3348, "maximum": 247.7003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 171.6, "10th_percentile": 171.6, "90th_percentile": 171.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 181.29, "10th_percentile": 181.29, "90th_percentile": 181.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 188.76, "10th_percentile": 188.76, "90th_percentile": 198.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6196) ALGINATE DRESSING <=16 SQ IN", "code_information": [ { "code": "A6196", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 10.1942, "maximum": 17.7407, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3650) SO 8 ABD RESTRAINT PRE OTS", "code_information": [ { "code": "L3650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 82.0, "minimum": 80.3193, "maximum": 139.7777, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 82.65, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.39, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.32, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 82.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 82.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 82.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "959", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23439.0, "minimum": 18299.3, "maximum": 53199.4159, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22533.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 53199.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22533.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22533.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46703.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23439.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18299.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23439.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46703.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22533.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 23439.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22533.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32743.34 } ] } ] }, { "description": "HC (SUP SHELL Q4124) OASIS TRI-LAYER WOUND MATRIX", "code_information": [ { "code": "Q4124", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 19.5435, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PORPHYRINS URINE QUAN&FXJ", "code_information": [ { "code": "84120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 456.25, "discounted_cash": 14.0, "minimum": 14.2952, "maximum": 397.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST", "code_information": [ { "code": "71250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2460.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 2145.6694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1138.7, "10th_percentile": 1138.7, "90th_percentile": 1138.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1317.3, "10th_percentile": 1317.3, "90th_percentile": 1370.0, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 751.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1491.16, "10th_percentile": 1491.16, "90th_percentile": 1491.16, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1491.16, "10th_percentile": 1299.0, "90th_percentile": 1566.33, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM RENAL FLOW/FUNCT IMAGE,PHARM RX", "code_information": [ { "code": "78708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1485.31, "discounted_cash": 535.0, "minimum": 445.593, "maximum": 1485.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1485.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1485.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1485.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1053.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28142.0, "minimum": 24250.96, "maximum": 112924.7412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27046.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 64375.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27046.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27046.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 77047.37 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24250.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 77047.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27046.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28142.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27046.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39622.1 } ] } ] }, { "description": "HC DIGITAL BREAST TOMOSYNTHESIS BILAT - G0279 - 40100011", "code_information": [ { "code": "G0279", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 796.88, "discounted_cash": 11.0, "minimum": 11.3506, "maximum": 694.8794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED - 80338 - 31080338", "code_information": [ { "code": "80338", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 438.13, "minimum": 66.9018, "maximum": 382.0494, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.9 } ] } ] }, { "description": "HC COLLECT BLOOD FROM IMPLANT VENOUS ACCESS", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.38, "discounted_cash": 131.0, "minimum": 11.814, "maximum": 39.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 26.4, "10th_percentile": 26.4, "90th_percentile": 26.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEVEL TST PHYS/QHP EA ADDL", "code_information": [ { "code": "96113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 290.31, "minimum": 87.093, "maximum": 253.1503, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Piperacillin Sod-Tazobactam Na For Inj 3.375 GM (3-0.375 GM)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505615700", "type": "NDC" }, { "code": "J2543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.408, "maximum": 2.408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 72.41, "10th_percentile": 72.41, "90th_percentile": 72.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.41 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 85.34, "10th_percentile": 85.34, "90th_percentile": 170.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 99.93, "10th_percentile": 99.93, "90th_percentile": 99.93, "count": "1 through 10" } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [ { "code": "480", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23197.0, "minimum": 20355.63, "maximum": 77425.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22301.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 52624.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22301.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 63653.62, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 82020.65, "10th_percentile": 82020.65, "90th_percentile": 82020.65, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22301.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 77425.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23197.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20355.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23197.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 77425.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22301.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 23197.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22301.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32389.67 } ] } ] }, { "description": "HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT - G0108 - 42998960", "code_information": [ { "code": "G0108", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.69, "discounted_cash": 53.0, "minimum": 28.407, "maximum": 94.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.77, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.82, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [ { "code": "204", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7188.0, "minimum": 5613.2, "maximum": 25645.4415, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6940.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14589.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6940.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6940.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12675.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7188.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5613.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7188.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12675.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6940.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7188.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6940.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8979.64 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14320.0, "minimum": 12325.5, "maximum": 39008.5068, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13783.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31533.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13783.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13783.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21470.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14320.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12325.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14320.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21470.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13783.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14320.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13783.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19408.44 } ] } ] }, { "description": "HC (SUP SHELL A6531) COMPRESSION STOCKING BK30-40", "code_information": [ { "code": "A6531", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 61.0, "minimum": 59.9212, "maximum": 104.2794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 104.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TIB PLAT FX W/WO MANIP", "code_information": [ { "code": "27532", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.75, "discounted_cash": 3228.0, "minimum": 263.625, "maximum": 878.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "322", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14456.0, "minimum": 12522.07, "maximum": 55418.4718, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 49889.34, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 49959.58, "10th_percentile": 45879.46, "90th_percentile": 63126.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31857.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 47156.54, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 55307.35, "10th_percentile": 46343.39, "90th_percentile": 89610.35, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 48472.1, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 37573.55, "10th_percentile": 37573.55, "90th_percentile": 37573.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 48624.62, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 65894.27, "10th_percentile": 61573.4, "90th_percentile": 68640.66, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 45756.92 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14456.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12522.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14456.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45756.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 55418.47, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 51104.37, "10th_percentile": 46539.45, "90th_percentile": 78072.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14456.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19607.52 } ] } ] }, { "description": "HC INSERT TUNNELED CV CATH WITH PORT", "code_information": [ { "code": "36561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7466.88, "discounted_cash": 3115.0, "minimum": 2240.064, "maximum": 7466.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 4486.2, "10th_percentile": 4486.2, "90th_percentile": 4486.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7466.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7466.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7466.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 7264.29, "10th_percentile": 7264.29, "90th_percentile": 7264.29, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 4490.97, "10th_percentile": 4490.97, "90th_percentile": 4490.97, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 4513.93, "10th_percentile": 4298.9, "90th_percentile": 4513.93, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 4622.28, "10th_percentile": 4622.28, "90th_percentile": 4622.28, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 4934.82, "10th_percentile": 4513.93, "90th_percentile": 4934.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEPATIC FUNCTION PANEL", "code_information": [ { "code": "80076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.56, "discounted_cash": 8.0, "minimum": 7.9396, "maximum": 249.8803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 173.0, "10th_percentile": 36.52, "90th_percentile": 173.0, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 146.03, "10th_percentile": 137.75, "90th_percentile": 146.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 148.26, "10th_percentile": 148.26, "90th_percentile": 154.22, "count": "18" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 36.52, "10th_percentile": 36.52, "90th_percentile": 173.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 199.91, "10th_percentile": 42.87, "90th_percentile": 199.91, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4424) OST PCH DRAIN W BAR & FILTER - A4424 - 27200086", "code_information": [ { "code": "A4424", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.5888, "maximum": 11.4663, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.39, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.59, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" } ] } ] }, { "description": "Cyanocobalamin Inj 1000 MCG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00517003101", "type": "NDC" }, { "code": "J3420", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.4405, "maximum": 1.4405, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.44 } ] } ] }, { "description": "HC (SUP SHELL Q4152) DERMAPURE 1 SQUARE CM", "code_information": [ { "code": "Q4152", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 117.433, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4330) STOOL COLLECTION POUCH - A4330 - 27100005", "code_information": [ { "code": "A4330", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 9.9221, "maximum": 17.2672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC XRAY HIP W PELVIS, UNILAT 1 VW", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 437.81, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECTION THERAPY OF VEIN", "code_information": [ { "code": "36470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450.63, "discounted_cash": 401.0, "minimum": 135.189, "maximum": 450.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 450.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 450.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 450.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 450.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT PICC W/O SUB-Q PORT <5 Y/O", "code_information": [ { "code": "36568", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5156.88, "discounted_cash": 1553.0, "minimum": 1547.064, "maximum": 5156.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5156.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5156.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5156.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEEDLE BIOPSY LIVER", "code_information": [ { "code": "47000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4096.25, "discounted_cash": 1629.0, "minimum": 1228.875, "maximum": 4096.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2189.56, "10th_percentile": 2189.56, "90th_percentile": 2189.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4096.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4096.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4096.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2337.72, "10th_percentile": 2337.72, "90th_percentile": 2337.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17151.0, "minimum": 15878.22, "maximum": 45792.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16500.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38261.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16500.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16500.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 45791.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17151.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15878.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17151.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45792.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16500.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17151.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16500.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23549.05 } ] } ] }, { "description": "HC INCISE EXTERNAL HEMORRHOID", "code_information": [ { "code": "46083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1031.88, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1031.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1031.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE PHOSPHORUS", "code_information": [ { "code": "84105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.44, "discounted_cash": 5.0, "minimum": 5.617, "maximum": 85.8397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.62, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SHOULDER 1 VW", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.38, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 222.77, "10th_percentile": 222.77, "90th_percentile": 222.77, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC PRETREATMENT/CHEM OR DRUGS", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "discounted_cash": 58.0, "minimum": 43.5, "maximum": 145.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 145.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TISSUE CULTURE, BONE MARROW", "code_information": [ { "code": "88237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 841.25, "discounted_cash": 143.0, "minimum": 139.6962, "maximum": 754.285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 174.61, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 139.7, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 754.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 769.98, "10th_percentile": 769.98, "90th_percentile": 769.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.11, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC APPLY LOWER LEG SPLINT", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.06, "discounted_cash": 160.0, "minimum": 85.218, "maximum": 284.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 284.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 284.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 284.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLOT INHIB PROTEIN C,ANTIGEN", "code_information": [ { "code": "85302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.19, "discounted_cash": 12.0, "minimum": 11.6713, "maximum": 76.0297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATH/INJECT HYSTEROSALPINGOGRAM", "code_information": [ { "code": "58340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.38, "minimum": 79.314, "maximum": 230.5394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 166.03, "10th_percentile": 166.03, "90th_percentile": 167.51, "count": "1 through 10" } ] } ] }, { "description": "HC XRAY HIPS W PELVIS, BILAT 3-4 VW", "code_information": [ { "code": "73522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 714.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 622.6603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 351.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MR SAFETY IMPLANT&/FB ASSMT CLIN STAF 1ST 15 MIN", "code_information": [ { "code": "76014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.88, "discounted_cash": 28.0, "minimum": 27.564, "maximum": 91.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ", "code_information": [ { "code": "27268", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6643.44, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 6643.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6250.61, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6643.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6074.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PREPUTIAL STRETCHING", "code_information": [ { "code": "54450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1295.63, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1179.8186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19262.0, "minimum": 17149.67, "maximum": 49445.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18525.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 43275.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18525.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18525.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 49445.14 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19262.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17149.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19262.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49445.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18525.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19262.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18525.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26635.31 } ] } ] }, { "description": "HC RECONSTRUC OF NAIL BED", "code_information": [ { "code": "11760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 494.69, "discounted_cash": 729.0, "minimum": 148.407, "maximum": 494.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 494.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Sod Ferric Gluc Cmplx in Sucrose IV Soln 12.5 MG/ML (Fe Eq)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00143957001", "type": "NDC" }, { "code": "J2916", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.171, "maximum": 4.171, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 221.9, "10th_percentile": 221.9, "90th_percentile": 221.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.17 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC", "code_information": [ { "code": "841", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13455.0, "minimum": 10852.65, "maximum": 40352.5499, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34179.84 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13455.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10852.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13455.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34179.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12953.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13455.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12953.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18143.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12953.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29479.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12953.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12953.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC EPHYS EVAL W ABLATION VENTRICULAR TACHYCARDIA", "code_information": [ { "code": "93654", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60116.9, "discounted_cash": 25790.0, "minimum": 18035.07, "maximum": 60116.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60116.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60116.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60116.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28111.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43616.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Haemophilus B Polysaccharide Conjugate Vaccine For Inj", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "49281054758", "type": "NDC" }, { "code": "90648", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 28.595, "maximum": 28.595, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 316.63, "10th_percentile": 316.63, "90th_percentile": 316.63, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.6 } ] } ] }, { "description": "HC PULMONARY VENTILATION IMAGING", "code_information": [ { "code": "78579", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 891.56, "discounted_cash": 394.0, "minimum": 267.468, "maximum": 891.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 891.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 891.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 891.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 891.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OBSERVATION PER HOUR", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.25, "minimum": 45.375, "maximum": 131.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 813.12, "10th_percentile": 813.12, "90th_percentile": 887.04, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 6154.97, "10th_percentile": 4297.9, "90th_percentile": 7458.29, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 553.72, "10th_percentile": 92.29, "90th_percentile": 1107.44, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1914.39, "10th_percentile": 1914.39, "90th_percentile": 1914.39, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 806.85, "10th_percentile": 189.97, "90th_percentile": 1344.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2215.74, "10th_percentile": 2215.74, "90th_percentile": 2215.74, "count": "1 through 10" } ] } ] }, { "description": "HC CHORIONIC GONADOTROPIN, QUANT", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.44, "discounted_cash": 15.0, "minimum": 14.6256, "maximum": 181.7597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 112.06, "10th_percentile": 112.06, "90th_percentile": 133.4, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 106.22, "10th_percentile": 106.22, "90th_percentile": 106.22, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 112.17, "10th_percentile": 112.17, "90th_percentile": 114.32, "count": "20" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 67.27, "10th_percentile": 67.27, "90th_percentile": 133.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 145.41, "10th_percentile": 78.97, "90th_percentile": 146.74, "count": "33" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY,SMALL BOWEL,W/MULT SERIAL FILMS", "code_information": [ { "code": "74250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1262.5, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1100.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 737.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN", "code_information": [ { "code": "99366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.69, "minimum": 50.907, "maximum": 147.9697, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC NEEDLE BIOPSY,MUSCLE", "code_information": [ { "code": "20206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1458.75, "discounted_cash": 1629.0, "minimum": 437.625, "maximum": 1458.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1458.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5200) PERCUTANEOUS CATHETER ANCHOR", "code_information": [ { "code": "A5200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 16.0, "minimum": 15.6654, "maximum": 27.2621, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.58, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THYROID MET IMAGING BODY", "code_information": [ { "code": "78018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2139.69, "discounted_cash": 535.0, "minimum": 535.74, "maximum": 2139.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2110.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2139.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2051.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2139.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI ABDOMEN WO/W CONTRAST", "code_information": [ { "code": "74183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3609.06, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 3147.1003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1940.23, "10th_percentile": 1940.23, "90th_percentile": 1940.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2149.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 414.77, "10th_percentile": 414.77, "90th_percentile": 945.36, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Calcium Gluconate Inj 10%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323036001", "type": "NDC" }, { "code": "J0612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CT UPPER EXTREMITY WO CONTRAST", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1879.38, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1638.8194, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1041.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 433.55, "10th_percentile": 433.55, "90th_percentile": 456.02, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 983.16, "10th_percentile": 983.16, "90th_percentile": 983.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 433.55, "10th_percentile": 433.55, "90th_percentile": 433.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 } ] } ] }, { "description": "HC (SUP SHELL A4389) DRAINABLE PCH W ST WEAR BARR", "code_information": [ { "code": "A4389", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.5907, "maximum": 14.9502, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN OF PELVIS COMBO", "code_information": [ { "code": "72194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3336.25, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2909.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1778.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD CLOT FACTOR VII TEST", "code_information": [ { "code": "85230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 333.44, "discounted_cash": 17.0, "minimum": 17.3952, "maximum": 290.7597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.74, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BONE MARROW,SMEAR INTERPRETATION", "code_information": [ { "code": "85097", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.13, "discounted_cash": 794.0, "minimum": 96.939, "maximum": 323.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 323.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SPLENIC PROCEDURES WITH CC", "code_information": [ { "code": "800", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22414.0, "minimum": 20167.37, "maximum": 50765.4085, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21550.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 50765.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21550.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21550.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48270.29 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22414.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20167.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22414.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48270.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21550.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22414.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21550.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31245.25 } ] } ] }, { "description": "HC OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES - G0463 - 76100005", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.25, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 356.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 356.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 356.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8203.0, "minimum": 6326.79, "maximum": 17001.9125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17001.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 7719.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8203.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6326.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8203.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7719.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8203.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10464.39 } ] } ] }, { "description": "HC ASSAY OF INTERLEUKIN-6 (IL-6)", "code_information": [ { "code": "83529", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.0, "discounted_cash": 17.0, "minimum": 16.783, "maximum": 283.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 90.62, "10th_percentile": 90.62, "90th_percentile": 90.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ELEC STIM OTHER THAN WOUND - G0283 - 42000014", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.63, "discounted_cash": 12.0, "minimum": 11.7199, "maximum": 80.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "156", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6304.0, "minimum": 4653.9, "maximum": 17362.7321, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6091.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12488.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6091.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6091.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9599.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6304.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4653.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6304.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9599.51 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6091.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6304.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6091.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7686.19 } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "820", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45652.0, "minimum": 40298.06, "maximum": 154676.5634, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43847.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 105976.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 43847.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 43847.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 75724.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 45652.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40298.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45652.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75724.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43847.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 45652.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 43847.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65226.43 } ] } ] }, { "description": "HC (SUP SHELL Q4196) PURAPLY PER SQ CM", "code_information": [ { "code": "Q4196", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMV RECTAL OBSTR:FECES/F.B. W ANEST", "code_information": [ { "code": "45915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 435.63, "discounted_cash": 1180.0, "minimum": 130.689, "maximum": 435.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 5511.24, "10th_percentile": 5511.24, "90th_percentile": 5511.24, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "165", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15606.0, "minimum": 12901.36, "maximum": 53611.5842, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34589.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39722.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15606.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12901.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15606.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39722.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15606.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15017.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21289.12 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15823.0, "minimum": 12687.49, "maximum": 52248.1995, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15226.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35106.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15226.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15226.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34682.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15823.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12687.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15823.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34682.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15226.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15823.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15226.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21607.2 } ] } ] }, { "description": "HC BETA 2 GLYCOPROTEIN I ANTIBODY,EA", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.38, "discounted_cash": 25.0, "minimum": 24.7323, "maximum": 133.5412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 113.76, "10th_percentile": 113.76, "90th_percentile": 113.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 213.08, "10th_percentile": 213.08, "90th_percentile": 213.08, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 79.55, "10th_percentile": 76.44, "90th_percentile": 229.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 98.12, "10th_percentile": 98.12, "90th_percentile": 103.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IN-SITU VEIN BYPASS FEMORAL-POPLITEAL", "code_information": [ { "code": "35583", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30151.6, "minimum": 9045.48, "maximum": 26292.1952, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14987.57 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14104.0, "minimum": 11333.68, "maximum": 37265.6089, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13576.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31022.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13576.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13576.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30300.68 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11333.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30300.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13576.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13576.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19093.7 } ] } ] }, { "description": "HC PERQ TRANSCATH RTRVL INTRVAS FB W IMG", "code_information": [ { "code": "37197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9359.38, "discounted_cash": 3115.0, "minimum": 2807.814, "maximum": 9359.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9359.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9359.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9359.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY WITHOUT CCMCC", "code_information": [ { "code": "714", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9089.0, "minimum": 6503.97, "maximum": 21661.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8764.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19107.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8764.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8764.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21661.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9089.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6503.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9089.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21661.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8764.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9089.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8764.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11760.06 } ] } ] }, { "description": "HC X-RAY FOREARM 2 VW", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.38, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 85.24, "10th_percentile": 85.24, "90th_percentile": 85.24, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 190.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 291.72, "10th_percentile": 269.46, "90th_percentile": 306.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC APPLY MULTLAY COMPRS LWR LEG", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 602.5, "discounted_cash": 160.0, "minimum": 160.33, "maximum": 602.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 602.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 602.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 602.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT UPPER EXTREMITY W CONTRAST", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2008.13, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1751.0894, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1330.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INSERT TEMP PM/ELECTRODE SINGLE CHMBR", "code_information": [ { "code": "33210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16404.7, "discounted_cash": 8165.0, "minimum": 4921.41, "maximum": 16404.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16404.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16404.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16404.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SMALL BOWEL ENTEROCLYSIS", "code_information": [ { "code": "74251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1381.25, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1381.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1381.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dobutamine in Dextrose 5% Inj 1 MG/ML", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "00338107302", "type": "NDC" }, { "code": "J1250", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.5225, "maximum": 17.5225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 43.61, "10th_percentile": 43.61, "90th_percentile": 43.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.52 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41606.0, "minimum": 36660.21, "maximum": 124047.6122, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 96362.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 39965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 39965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 100371.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 41606.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36660.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41606.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 100371.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 41606.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39965.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59309.7 } ] } ] }, { "description": "HC MOPATH PROCEDURE LEVEL 1", "code_information": [ { "code": "81400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 757.81, "discounted_cash": 63.0, "minimum": 62.1563, "maximum": 660.8103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.69, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.16, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.17, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6197) ALGINATE DRSG >16 <=48 SQ IN - A6197 - RU272040", "code_information": [ { "code": "A6197", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "minimum": 22.779, "maximum": 39.6417, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITH CC", "code_information": [ { "code": "386", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8473.0, "minimum": 6869.42, "maximum": 26488.2538, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 23845.5, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9541.35, "10th_percentile": 7909.97, "90th_percentile": 14946.09, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8172.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17641.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8172.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 23168.11, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11333.59, "10th_percentile": 11333.59, "90th_percentile": 11333.59, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8172.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17106.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8473.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6869.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8473.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17106.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8172.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8473.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8172.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10858.1 } ] } ] }, { "description": "Pamidronate Disodium IV Soln 3 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "67457043010", "type": "NDC" }, { "code": "J2430", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.842, "maximum": 29.842, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.84 } ] } ] }, { "description": "HC SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTER/S&I BILA", "code_information": [ { "code": "36254", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9039.06, "discounted_cash": 3115.0, "minimum": 2711.718, "maximum": 9039.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLATELET PHERESIS IRRADIATED, PER UNIT", "code_information": [ { "code": "P9036", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4606.56, "discounted_cash": 944.0, "minimum": 944.48, "maximum": 4519.9979, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3720.87, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4520.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3616.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1029.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1597.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RESTRATA, PER SQ CM (SUP SHELL A2007)", "code_information": [ { "code": "A2007", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ULTRASOUND THERAPY EA 15 MIN", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.5, "discounted_cash": 13.0, "minimum": 13.2845, "maximum": 102.46, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.12, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.6, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BORDETELLA ANTIBODY", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 580.0, "discounted_cash": 13.0, "minimum": 12.818, "maximum": 505.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 96.16, "10th_percentile": 96.16, "90th_percentile": 96.16, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG", "code_information": [ { "code": "64451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3008.44, "discounted_cash": 696.0, "minimum": 696.49, "maximum": 3008.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3008.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Iopamidol Inj 61%", "drug_information": { "unit": 15.0, "type": "ML" }, "code_information": [ { "code": "00270141215", "type": "NDC" }, { "code": "Q9967", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 50.78, "10th_percentile": 50.78, "90th_percentile": 50.78, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC XRAY UPPER GI TRACT", "code_information": [ { "code": "74240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1357.19, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1183.4697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 327.03, "10th_percentile": 327.03, "90th_percentile": 327.03, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 745.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 832.34, "10th_percentile": 832.34, "90th_percentile": 832.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4412) OST POUCH DRAIN HIGH OUTPUT", "code_information": [ { "code": "A4412", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.7511, "maximum": 6.528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.75, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3915) WHO NONTORSION JNTS PRE CST", "code_information": [ { "code": "L3915", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 580.0, "minimum": 563.9161, "maximum": 981.3695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 580.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 580.28, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 704.87, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 580.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 563.92, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 580.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 580.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 580.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 632.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 580.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 580.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 580.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 580.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 580.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 981.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4455) ADHESIVE REMOVER PER OUNCE", "code_information": [ { "code": "A4455", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 1.9728, "maximum": 3.4331, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.47, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.97, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOFLUOR ANTB 1ST STAIN", "code_information": [ { "code": "88346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.5, "discounted_cash": 168.0, "minimum": 48.75, "maximum": 162.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Tab 4 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00054817525", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL Q4046) CAST SUP SHT LEG SPLNT FBRGL", "code_information": [ { "code": "Q4046", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "minimum": 23.1191, "maximum": 40.2336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.9, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4624) TRACHEAL SUCTION TUBE - A4624 - RU272034", "code_information": [ { "code": "A4624", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.1098, "maximum": 5.4118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Tab 2 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00054817625", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Antihemophilic Factor/VWF (Human) For Inj 1000-1000 Unit Kit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68982018202", "type": "NDC" }, { "code": "J7183", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.2536, "maximum": 5.2003, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.23, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.57, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND SMP FACE 12.6-20 CM", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 654.38, "discounted_cash": 401.0, "minimum": 196.314, "maximum": 654.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 654.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 654.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 654.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 654.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THROMBIN TIME, PLASMA", "code_information": [ { "code": "85670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.38, "discounted_cash": 5.0, "minimum": 5.6073, "maximum": 77.9394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MACROSCOPIC EXAM, PARASITE", "code_information": [ { "code": "87169", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.63, "discounted_cash": 4.0, "minimum": 4.1885, "maximum": 83.3894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.24, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, PELVIS, W/O CONTRAST", "code_information": [ { "code": "72195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2691.88, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2347.3194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1465.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RMV PULSE GENERATOR,SNGL/DUAL", "code_information": [ { "code": "33241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7560.31, "discounted_cash": 3687.0, "minimum": 2268.093, "maximum": 7560.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4019.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6235.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6455) SELF-ADHER BAND >=5/YD - A6455 - 27100030", "code_information": [ { "code": "A6455", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.9339, "maximum": 3.3655, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.93, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US, HEAD, REAL TIME", "code_information": [ { "code": "76506", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 641.56, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 641.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 641.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLATELET ANTIBODIES", "code_information": [ { "code": "86022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1070.0, "discounted_cash": 18.0, "minimum": 17.852, "maximum": 933.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.31, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX", "code_information": [ { "code": "37213", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8061.25, "discounted_cash": 3115.0, "minimum": 2418.375, "maximum": 8061.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8061.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8061.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8061.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL", "code_information": [ { "code": "35221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15461.6, "minimum": 4638.48, "maximum": 14987.5733, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14987.57 } ] } ] }, { "description": "HC ASSAY, SERUM CHOLINESTERASE", "code_information": [ { "code": "82480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.44, "discounted_cash": 7.0, "minimum": 7.6481, "maximum": 212.2797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.56, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.65, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY HYSTEROSALPINGOGRAM", "code_information": [ { "code": "74740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1240.31, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1126.6495, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 286.08, "10th_percentile": 286.08, "90th_percentile": 286.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 947.07, "10th_percentile": 947.07, "90th_percentile": 947.07, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 664.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT MID HUMERUS XF WO MANIP", "code_information": [ { "code": "24500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 550.31, "discounted_cash": 243.0, "minimum": 165.093, "maximum": 550.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 550.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 550.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 550.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Benztropine Mesylate Inj 1 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00143972905", "type": "NDC" }, { "code": "J0515", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 36.0555, "maximum": 36.0555, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.06 } ] } ] }, { "description": "HC PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB", "code_information": [ { "code": "93283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 343.75, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 299.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "601", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5649.0, "minimum": 4149.34, "maximum": 10932.2532, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5463.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 10932.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5463.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5463.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 7101.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5649.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4149.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5649.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7101.72 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5463.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5649.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5463.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6728.62 } ] } ] }, { "description": "HC APPLY LONG LEG SPLINT", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.31, "discounted_cash": 160.0, "minimum": 67.593, "maximum": 225.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 225.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 225.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 225.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 225.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC Q FEVER ANTIBODY", "code_information": [ { "code": "86638", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 366.56, "discounted_cash": 12.0, "minimum": 11.7782, "maximum": 319.6403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC", "code_information": [ { "code": "243", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17254.0, "minimum": 15592.37, "maximum": 78453.1877, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16598.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38505.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16598.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16598.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46230.37 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15592.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46230.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16598.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17254.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16598.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23699.19 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12926.0, "minimum": 11339.91, "maximum": 35552.6935, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12446.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28223.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12446.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 31194.23, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18179.57, "10th_percentile": 18179.57, "90th_percentile": 18179.57, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12446.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34475.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12926.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11339.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12926.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34476.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12446.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12926.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12446.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17370.95 } ] } ] }, { "description": "HC T CELL ABSOLUTE COUNT", "code_information": [ { "code": "86361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 317.19, "discounted_cash": 26.0, "minimum": 26.0248, "maximum": 276.5897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 160.6, "10th_percentile": 160.6, "90th_percentile": 160.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.02, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 143.12, "10th_percentile": 137.63, "90th_percentile": 143.12, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 119.71, "10th_percentile": 119.71, "90th_percentile": 119.71, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 140.52, "10th_percentile": 140.52, "90th_percentile": 185.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C9354) ACCELLULR PERICARDIAL TISS NH SQ CM", "code_information": [ { "code": "C9354", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 41.667, "maximum": 41.667, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.67 } ] } ] }, { "description": "HC (SUP SHELL Q4225) AMNIO OR DERMA TL, PER SQ CM", "code_information": [ { "code": "Q4225", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 2982.2435, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2982.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3807) WHF ORTHOS NO JNT PRFAB CUSTOM FIT", "code_information": [ { "code": "L3807", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 272.0, "minimum": 265.2722, "maximum": 461.6469, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.65, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 331.58, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 265.27, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 297.54, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HC BREATHING CAPACITY TEST", "code_information": [ { "code": "94010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 424.06, "discounted_cash": 213.0, "minimum": 127.218, "maximum": 424.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 255.82, "10th_percentile": 255.82, "90th_percentile": 255.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 424.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 424.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 424.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 295.83, "10th_percentile": 295.83, "90th_percentile": 295.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF BLOOD OSMOLALITY", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.94, "discounted_cash": 6.0, "minimum": 6.4236, "maximum": 96.7397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 29.55, "10th_percentile": 29.55, "90th_percentile": 29.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.42, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 60.85, "10th_percentile": 60.85, "90th_percentile": 60.85, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 77.39, "10th_percentile": 77.39, "90th_percentile": 78.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylergonovine Maleate Inj 0.2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00517074001", "type": "NDC" }, { "code": "J2210", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 45.7735, "maximum": 45.7735, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.77 } ] } ] }, { "description": "HC INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB - 93261 - 48193261", "code_information": [ { "code": "93261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.81, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 176.2095, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LACOSAMIDE IVPB 100 MG/100 ML (NS)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "09999401300", "type": "NDC" }, { "code": "C9254", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [ { "code": "300", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9166.0, "minimum": 7409.98, "maximum": 32333.9409, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19289.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16738.25 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9166.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7409.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9166.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16738.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9166.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11872.39 } ] } ] }, { "description": "HC INSERT/RPLACMNT AICD W LEAD SING/DUAL", "code_information": [ { "code": "33249", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135898.0, "discounted_cash": 30971.0, "minimum": 30971.47, "maximum": 135898.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 122015.2, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135898.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118580.47, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33758.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52378.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC N.GONORRHOEAE, DNA, AMP PROB", "code_information": [ { "code": "87591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.81, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 147.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 89.2, "10th_percentile": 74.93, "90th_percentile": 118.25, "count": "34" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 71.03, "10th_percentile": 71.03, "90th_percentile": 75.33, "count": "26" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 79.55, "10th_percentile": 76.44, "90th_percentile": 79.55, "count": "37" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 111.5, "10th_percentile": 89.2, "90th_percentile": 118.25, "count": "16" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 103.11, "10th_percentile": 103.11, "90th_percentile": 103.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6402) STERILE GAUZE <= 16 SQ IN - A6402 - 27200152", "code_information": [ { "code": "A6402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC APPLY FOREARM SPLINT STATIC", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.88, "discounted_cash": 131.0, "minimum": 107.064, "maximum": 356.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 182.78, "10th_percentile": 182.78, "90th_percentile": 182.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 356.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 356.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 356.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 224.12, "10th_percentile": 224.12, "90th_percentile": 224.12, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4133) GRAFIX PRIME", "code_information": [ { "code": "Q4133", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 293.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17860.0, "minimum": 13305.26, "maximum": 39945.1883, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14851.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17860.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13305.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17180.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17860.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17180.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24585.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17180.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39945.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17180.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17180.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13305.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17860.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3762) EO RIGID W/O JOINTS PRE OTS", "code_information": [ { "code": "L3762", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 117.0, "minimum": 114.0699, "maximum": 198.5131, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 142.58, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.07, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 117.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 117.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 117.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 117.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 198.51, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN", "code_information": [ { "code": "97755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.88, "discounted_cash": 36.0, "minimum": 35.2569, "maximum": 197.8394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.07, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35.26, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR OF VAGINA", "code_information": [ { "code": "57200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9590.31, "discounted_cash": 3194.0, "minimum": 2877.093, "maximum": 9590.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9590.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9590.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9590.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3481.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5401.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20663.0, "minimum": 16591.81, "maximum": 105193.0369, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19870.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 46605.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19870.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19870.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 50943.42 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20663.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16591.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20663.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50943.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19870.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20663.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19870.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28685.04 } ] } ] }, { "description": "HC TRG GENE REARRANGEMENT ANAL", "code_information": [ { "code": "81342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1025.0, "discounted_cash": 201.0, "minimum": 195.8177, "maximum": 1025.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 244.76, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 195.82, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 219.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 340.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4159) AFFINITY", "code_information": [ { "code": "Q4159", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 565.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Esmolol HCl-Sodium Chloride IV Soln 2500 MG/250ML", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "67457065725", "type": "NDC" }, { "code": "J1805", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A4565) SLINGS - A4565 - 27100006", "code_information": [ { "code": "A4565", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 10.6704, "maximum": 18.5694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY FACIAL BONES <3 VW", "code_information": [ { "code": "70140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 385.0, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 385.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 385.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 198.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEBRIDEMENT OF NAILS, 1-5", "code_information": [ { "code": "11720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 58.0, "minimum": 42.0, "maximum": 140.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3809) WHFO W/O JOINTS PRE OTS", "code_information": [ { "code": "L3809", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 272.0, "minimum": 265.2722, "maximum": 461.6469, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 331.58, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 265.27, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 297.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTHER,IA PUSH TECHNIQUE", "code_information": [ { "code": "96420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 625.31, "discounted_cash": 325.0, "minimum": 187.593, "maximum": 625.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 625.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 551.18, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 625.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 625.31, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "Insulin Lispro Inj 100 Unit/ML", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00002822201", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2", "code_information": [ { "code": "81401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1861.88, "discounted_cash": 137.0, "minimum": 133.1366, "maximum": 1623.5594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.41, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 133.14, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 718.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 149.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4200) SKIN TE 1 SQ CM", "code_information": [ { "code": "Q4200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "858", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11641.0, "minimum": 8917.44, "maximum": 27520.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11213.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25169.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11213.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11213.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27520.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11641.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8917.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11641.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27520.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11213.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11641.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11213.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15491.39 } ] } ] }, { "description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC", "code_information": [ { "code": "522", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17153.0, "minimum": 14590.86, "maximum": 57524.845, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16502.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38266.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16502.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16502.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51185.01 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17153.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14590.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17153.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51185.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16502.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17153.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16502.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23552.38 } ] } ] }, { "description": "HC COMPLEMENT, TOTAL (CH50)", "code_information": [ { "code": "86162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.31, "discounted_cash": 20.0, "minimum": 19.747, "maximum": 274.9503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.15, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PLASMA HEMOGLOBIN", "code_information": [ { "code": "83051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 425.31, "discounted_cash": 7.0, "minimum": 7.1039, "maximum": 370.8703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6403) STERILE GAUZE>16 <= 48 SQ IN - A6403 - 27200153", "code_information": [ { "code": "A6403", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS", "code_information": [ { "code": "78451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4980.31, "discounted_cash": 1277.0, "minimum": 1277.43, "maximum": 4980.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4980.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4980.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4890.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2193.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1392.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2160.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA", "code_information": [ { "code": "76706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 769.8103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 538.66, "10th_percentile": 538.66, "90th_percentile": 538.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 710.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 320.41, "10th_percentile": 320.41, "90th_percentile": 320.41, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 102.92, "10th_percentile": 102.92, "90th_percentile": 102.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "555", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11100.0, "minimum": 9320.26, "maximum": 29170.9516, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10694.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23884.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10694.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10694.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28586.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11100.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9320.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11100.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28586.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10694.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11100.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10694.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14700.64 } ] } ] }, { "description": "HC MICROHEMATOCRIT,SPUN", "code_information": [ { "code": "85013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.81, "discounted_cash": 7.0, "minimum": 6.8026, "maximum": 63.4903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4166) CYTAL, PER SQUARE CENTIMETER", "code_information": [ { "code": "Q4166", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 46.225, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ketorolac Tromethamine Inj 15 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "72266023401", "type": "NDC" }, { "code": "J1885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.3434, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 14.27, "count": "39" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.34, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.27, "10th_percentile": 14.13, "90th_percentile": 14.84, "count": "15" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "741", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11894.0, "minimum": 9507.14, "maximum": 38696.11, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11455.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25769.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11455.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11455.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38696.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9507.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38696.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11455.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11455.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15860.63 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28165.0, "minimum": 24233.65, "maximum": 81252.6356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 64429.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 71291.73, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 41685.15, "10th_percentile": 41685.15, "90th_percentile": 41685.15, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 49558.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28165.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24233.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28165.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49558.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28165.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39655.46 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37772.0, "minimum": 33618.98, "maximum": 87253.8364, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36286.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 87253.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 36286.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36286.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 69797.57 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33618.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69797.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36286.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 37772.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36286.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53703.26 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13755.0, "minimum": 11658.29, "maximum": 41157.8796, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13241.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30192.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13241.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13241.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26376.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11658.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26376.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13241.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13241.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18583.22 } ] } ] }, { "description": "HC NM BONE IMAGING, LIMITED AREA", "code_information": [ { "code": "78300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 652.19, "discounted_cash": 394.0, "minimum": 195.657, "maximum": 652.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 652.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 652.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 652.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 652.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 652.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "819", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7587.0, "minimum": 4674.67, "maximum": 25583.9306, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15538.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17673.46 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7587.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4674.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7587.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17673.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7587.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7323.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9563.53 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30799.0, "minimum": 26312.82, "maximum": 84910.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29596.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 70687.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 29596.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 29596.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 84910.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 30799.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26312.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30799.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 84910.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29596.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 30799.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29596.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43506.9 } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "252", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27577.0, "minimum": 23742.93, "maximum": 111397.1253, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26504.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 63033.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26504.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26504.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 83424.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 27577.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23742.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27577.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 83424.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26504.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 27577.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26504.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38795.76 } ] } ] }, { "description": "HC INTRAVENTRICULAR PACING", "code_information": [ { "code": "93612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3347.19, "discounted_cash": 7695.0, "minimum": 1004.157, "maximum": 3347.19, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART", "code_information": [ { "code": "36222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9181.88, "discounted_cash": 3115.0, "minimum": 2754.564, "maximum": 9181.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEBRIDE SKIN SUB-Q TISS MUSCLE BONE =<20 SQ CM", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1268.13, "discounted_cash": 1629.0, "minimum": 380.439, "maximum": 1268.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1898.64, "10th_percentile": 1898.64, "90th_percentile": 1898.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1268.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERIPHERAL ARTERIAL DISEASE REHAB PER SESSION", "code_information": [ { "code": "93668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232.5, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 232.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 232.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP", "code_information": [ { "code": "94680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 290.94, "discounted_cash": 126.0, "minimum": 87.282, "maximum": 290.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 290.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 290.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 290.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRYPSIN FECES QUAN 24-HR", "code_information": [ { "code": "84490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.38, "discounted_cash": 9.0, "minimum": 9.65, "maximum": 60.4994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 MG/ML - 67457042200", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "67457042200", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "40" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 4.45, "90th_percentile": 14.84, "count": "24" } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "869", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6597.0, "minimum": 4980.59, "maximum": 13185.5622, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6373.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13185.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6373.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6373.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10094.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6597.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4980.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6597.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10094.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6373.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6597.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6373.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8115.49 } ] } ] }, { "description": "HC ENDOVENOUS RF, 1ST VEIN", "code_information": [ { "code": "36475", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30290.6, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 26413.4032, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12273.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14909.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CCMCC", "code_information": [ { "code": "578", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13265.0, "minimum": 11699.82, "maximum": 46688.5542, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12771.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29027.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12771.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12771.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36734.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13265.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11699.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13265.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36734.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12771.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13265.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12771.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17865.87 } ] } ] }, { "description": "HC CHEST WALL MANIPULATION,INITIAL", "code_information": [ { "code": "94667", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.56, "discounted_cash": 131.0, "minimum": 21.468, "maximum": 71.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC", "code_information": [ { "code": "350", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19999.0, "minimum": 16740.62, "maximum": 53891.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19233.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 45028.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19233.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19233.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 53891.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19999.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16740.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19999.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53891.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19233.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19999.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19233.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27714.11 } ] } ] }, { "description": "HC REMOVE,OBST MATL,CVA DEV VIA SEP VEN ACC", "code_information": [ { "code": "75901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1305.94, "minimum": 391.782, "maximum": 1305.94, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1305.94 } ] } ] }, { "description": "HC ST EVAL SPEECH SOUND PRODUCTION ARTICULATE, 15 MIN", "code_information": [ { "code": "92522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 433.75, "discounted_cash": 107.0, "minimum": 95.0, "maximum": 378.23, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 182.09, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.79, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.63, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD BODY/SCALP/EXTR 20.1-30 CM", "code_information": [ { "code": "12036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1836.25, "discounted_cash": 729.0, "minimum": 550.875, "maximum": 1836.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11174.0, "minimum": 9566.66, "maximum": 28796.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10765.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24059.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10765.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10765.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28796.57 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11174.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9566.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11174.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28796.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10765.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11174.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10765.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14808.52 } ] } ] }, { "description": "Octreotide Acetate Inj 50 MCG/ML (0.05 MG/ML)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641617401", "type": "NDC" }, { "code": "J2354", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.2685, "maximum": 1.2685, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.27 } ] } ] }, { "description": "HC MRA LOWER EXTREM W CONTRAST - C8912 - 61600001", "code_information": [ { "code": "C8912", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4708.75, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 4106.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [ { "code": "256", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13961.0, "minimum": 11722.66, "maximum": 68137.9056, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13438.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30680.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13438.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 59597.23, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 30677.58, "10th_percentile": 30677.58, "90th_percentile": 30677.58, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13438.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36720.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11722.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36720.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13438.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13961.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13438.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18883.5 } ] } ] }, { "description": "HC INS PICC RS&I W/O PORT<5YR", "code_information": [ { "code": "36572", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4173.44, "discounted_cash": 618.0, "minimum": 618.95, "maximum": 3639.2397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2438.42, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2962.11, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2369.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS", "code_information": [ { "code": "95117", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.31, "discounted_cash": 46.0, "minimum": 42.093, "maximum": 140.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE", "code_information": [ { "code": "51702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 489.38, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 489.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 489.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 489.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 489.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4311) CATHETER W/O BAG 2-WAY LATEX", "code_information": [ { "code": "A4311", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 19.0, "minimum": 19.3485, "maximum": 33.6718, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.67, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RANGE OF MOTION MEASUREMENTS - 95852 - 42000050", "code_information": [ { "code": "95852", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.88, "discounted_cash": 4.0, "minimum": 4.6646, "maximum": 71.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TACROLIMUS", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.06, "discounted_cash": 13.0, "minimum": 13.3428, "maximum": 265.1403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 154.22, "10th_percentile": 154.22, "90th_percentile": 154.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 72.04, "10th_percentile": 72.04, "90th_percentile": 72.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7521) TRACH/LARYN TUBE CUFFED", "code_information": [ { "code": "A7521", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 67.0, "minimum": 65.1495, "maximum": 113.378, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 113.38, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.43, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 65.15, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF FREE THYROXINE", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.5, "discounted_cash": 9.0, "minimum": 8.7656, "maximum": 220.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 161.6, "10th_percentile": 135.74, "90th_percentile": 161.6, "count": "46" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.96, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 154.13, "10th_percentile": 154.13, "90th_percentile": 154.13, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 135.89, "10th_percentile": 135.89, "90th_percentile": 138.49, "count": "55" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 40.32, "10th_percentile": 40.32, "90th_percentile": 161.6, "count": "14" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 176.14, "10th_percentile": 176.14, "90th_percentile": 176.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MOUTH PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "138", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7787.0, "minimum": 5630.5, "maximum": 16013.4922, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7515.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16013.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7515.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7515.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15664.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7787.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5630.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7787.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15664.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7515.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7787.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7515.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9856.03 } ] } ] }, { "description": "HC US,TRANSRECTAL,PROSTATE VOL", "code_information": [ { "code": "76873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 780.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 780.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 780.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY", "code_information": [ { "code": "33018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4845.31, "minimum": 1453.593, "maximum": 4845.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 4845.31 } ] } ] }, { "description": "RED BLOOD CELL DISORDERS WITHOUT MCC", "code_information": [ { "code": "812", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8031.0, "minimum": 6387.7, "maximum": 21384.5356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16591.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12681.78 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 21335.49, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15011.77, "10th_percentile": 15011.77, "90th_percentile": 15011.77, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8031.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6387.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8031.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12681.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8031.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7748.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10211.93 } ] } ] }, { "description": "Prothrombin Complex Concentrate Human-lans For Inj 500 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68982026101", "type": "NDC" }, { "code": "J7165", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.715, "maximum": 6.9015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.76, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.83, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY NASAL BONES", "code_information": [ { "code": "70160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 487.81, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 425.3703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 286.28, "10th_percentile": 286.28, "90th_percentile": 286.28, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT MC-P DISLOC W MANIP WO ANES", "code_information": [ { "code": "26700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 487.5, "discounted_cash": 243.0, "minimum": 146.25, "maximum": 487.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 487.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 487.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 487.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4385) OST SKN BARRIER SLD EXT WEAR", "code_information": [ { "code": "A4385", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.0553, "maximum": 12.2781, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL OF NAIL BED", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2376.88, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 2072.6394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1919.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB - C9600 - 48193261", "code_information": [ { "code": "C9600", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.81, "discounted_cash": 11390.0, "minimum": 52.875, "maximum": 27387.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 15499.44, "10th_percentile": 15499.44, "90th_percentile": 15499.44, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SECONDARY CLOSURE SURG WOUND DEHISCENSE COMPLICATED", "code_information": [ { "code": "13160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6280.94, "discounted_cash": 3496.0, "minimum": 1884.282, "maximum": 6280.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6280.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6280.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6280.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3811.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5913.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSION WITH MCC", "code_information": [ { "code": "304", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10098.0, "minimum": 8131.18, "maximum": 26931.7955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9732.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21503.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9732.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 23556.06, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 19002.58, "10th_percentile": 19002.58, "90th_percentile": 19002.58, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9732.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24461.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10098.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8131.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10098.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24461.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9732.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10098.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9732.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13234.8 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20765.0, "minimum": 17675.69, "maximum": 119544.6251, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19967.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 46846.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19967.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19967.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 45620.54 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20765.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17675.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20765.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45620.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19967.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20765.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19967.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28832.96 } ] } ] }, { "description": "Haloperidol Lactate Inj 5 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "67457042600", "type": "NDC" }, { "code": "J1630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.677, "maximum": 1.677, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.68 } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES", "code_information": [ { "code": "776", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6027.0, "minimum": 4938.37, "maximum": 13677.9824, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 12313.32, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 26867.21, "10th_percentile": 26867.21, "90th_percentile": 26867.21, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5825.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11830.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5825.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 11638.83, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15490.74, "10th_percentile": 15490.74, "90th_percentile": 15490.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 12001.17, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4068.83, "10th_percentile": 4068.83, "90th_percentile": 4068.83, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5825.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 7138.74 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6027.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4938.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6027.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7138.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 13677.98, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12683.98, "10th_percentile": 12683.98, "90th_percentile": 19690.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5825.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6027.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5825.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7281.36 } ] } ] }, { "description": "HC REM PAC CVDFB PLSE GEN &REPL PLSE GEN SNGL LEAD", "code_information": [ { "code": "33262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118780.0, "discounted_cash": 21947.0, "minimum": 21947.8, "maximum": 105035.5865, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86465.55, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105035.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84031.54, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23923.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37118.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS", "code_information": [ { "code": "23330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 813.44, "discounted_cash": 1629.0, "minimum": 244.032, "maximum": 813.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 813.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD NECK/HND/FT/GENT <2.5 CM", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PRQ DRUG ELUTING COR REVASC CHRO SIN - C9607 - 48100199", "code_information": [ { "code": "C9607", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27935.9, "discounted_cash": 18087.0, "minimum": 8380.77, "maximum": 27935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MR ANGIO, HEAD W/CONTRAST", "code_information": [ { "code": "70545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2434.38, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2122.7794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1559.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC XRAY SPINE, COMPLETE, 4-5 VW", "code_information": [ { "code": "72083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.19, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 590.5097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 549.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT FINGR ARTICULAR FX W MANIP EA", "code_information": [ { "code": "26742", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.75, "discounted_cash": 1586.0, "minimum": 263.625, "maximum": 878.75, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC THORACOTOMY,OPEN HEART MASSAGE", "code_information": [ { "code": "32160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6403.44, "minimum": 1921.032, "maximum": 6403.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6403.44 } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "383", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11548.0, "minimum": 8749.95, "maximum": 29860.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11124.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24949.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11124.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11124.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29860.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11548.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8749.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11548.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29860.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11124.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11548.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11124.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15355.7 } ] } ] }, { "description": "HC TUMOR IMAGING, WHOLE BODY, 2 OR MORE DAYS", "code_information": [ { "code": "78804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2830.63, "discounted_cash": 535.0, "minimum": 535.74, "maximum": 2830.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2110.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2563.89, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2051.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2830.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD OCCULT STOOL, 1-3 SIMULT, NON CAN SCREEN", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.0, "discounted_cash": 4.0, "minimum": 4.1107, "maximum": 47.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 18.91, "10th_percentile": 18.91, "90th_percentile": 18.91, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.11, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 38.37, "10th_percentile": 38.37, "90th_percentile": 38.37, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL OF ARTERY CLOT", "code_information": [ { "code": "34201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13209.4, "discounted_cash": 5490.0, "minimum": 3962.82, "maximum": 13209.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13209.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13209.4, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13209.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSRT/REP SUBQ DEFIBRILLATOR AND LEAD", "code_information": [ { "code": "33270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70027.5, "discounted_cash": 30971.0, "minimum": 21008.25, "maximum": 70027.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 44565.43, "10th_percentile": 44565.43, "90th_percentile": 44565.43, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70027.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70027.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 70027.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33758.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52378.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT ULNA SHAFT FX WO AMNIP", "code_information": [ { "code": "25530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "517", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12735.0, "minimum": 10331.47, "maximum": 49058.6032, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12262.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27767.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12262.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12262.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38908.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12735.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10331.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12735.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38908.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12262.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12735.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12262.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17090.69 } ] } ] }, { "description": "HC BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT", "code_information": [ { "code": "85004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.44, "discounted_cash": 6.0, "minimum": 6.2875, "maximum": 33.9494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 19.49, "10th_percentile": 19.49, "90th_percentile": 19.49, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT GR TUBER HUM FX W MANIP", "code_information": [ { "code": "23625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.75, "discounted_cash": 1586.0, "minimum": 263.625, "maximum": 878.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Calcitonin (Salmon) Inj 200 Unit/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "24201040002", "type": "NDC" }, { "code": "J0630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2456.1815, "maximum": 2456.1815, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2456.18 } ] } ] }, { "description": "HC IGH REARRANGE ABNORMAL CLONAL POP AMPLIFIED", "code_information": [ { "code": "81261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 875.0, "discounted_cash": 197.0, "minimum": 192.4067, "maximum": 875.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.84, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 240.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 192.41, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 875.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CULTURE ANAEROBE IDENT EACH", "code_information": [ { "code": "87076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.13, "discounted_cash": 8.0, "minimum": 7.8521, "maximum": 46.3294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 32.0, "10th_percentile": 32.0, "90th_percentile": 32.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 27.42, "10th_percentile": 27.42, "90th_percentile": 27.42, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT PROX TIB/FIB DISLOC WO ANES", "code_information": [ { "code": "27830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 723.75, "discounted_cash": 243.0, "minimum": 217.125, "maximum": 723.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 723.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 723.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 723.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0631) LSO SAG R AN/POS PNL PRE CST", "code_information": [ { "code": "L0631", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1231.0, "minimum": 1196.6551, "maximum": 2082.5099, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1231.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1231.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1495.76, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1231.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1196.66, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1231.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1231.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1231.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1342.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1231.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1231.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1231.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1231.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1231.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2082.51, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SEIZURES WITH MCC", "code_information": [ { "code": "100", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15778.0, "minimum": 13740.92, "maximum": 34997.6661, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15182.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34997.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15182.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15182.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31976.27 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15778.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13740.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15778.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31976.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15182.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15778.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15182.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21540.47 } ] } ] }, { "description": "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY", "code_information": [ { "code": "789", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14754.0, "minimum": 9540.2859, "maximum": 48184.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14200.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32565.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14200.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14200.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48184.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14754.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12476.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14754.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48184.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14200.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14754.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14200.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20043.49 } ] } ] }, { "description": "HC PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB", "code_information": [ { "code": "93282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.69, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 222.0897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT,NON-INDWELLING BLADDER CATHETER", "code_information": [ { "code": "51701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 329.06, "discounted_cash": 131.0, "minimum": 98.718, "maximum": 329.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 329.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 329.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 329.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RENAL FUNCTION STUDY", "code_information": [ { "code": "78725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 885.63, "discounted_cash": 394.0, "minimum": 265.689, "maximum": 885.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 885.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 885.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 885.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 702.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INCISION & DRAIN OF HEMATOMA/FLUID", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1120.63, "discounted_cash": 1629.0, "minimum": 336.189, "maximum": 1120.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1120.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11690.0, "minimum": 9918.27, "maximum": 29461.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11259.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25285.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11259.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11259.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29460.95 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11690.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9918.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11690.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29461.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11259.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11690.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11259.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15562.57 } ] } ] }, { "description": "HC NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL", "code_information": [ { "code": "64484", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3680.94, "minimum": 1104.282, "maximum": 3209.7797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1995.15, "10th_percentile": 1995.15, "90th_percentile": 1995.15, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY HAND 2 VW", "code_information": [ { "code": "73120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.69, "discounted_cash": 103.0, "minimum": 91.407, "maximum": 304.69, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 304.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 304.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 304.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 212.55, "10th_percentile": 212.55, "90th_percentile": 212.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNIZ ADMIN, INJ, INIT VAC", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.88, "discounted_cash": 71.0, "minimum": 8.064, "maximum": 26.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 14.45, "10th_percentile": 14.45, "90th_percentile": 14.45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 16.48, "10th_percentile": 16.48, "90th_percentile": 16.48, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.03, "10th_percentile": 17.03, "90th_percentile": 17.03, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 18.75, "10th_percentile": 18.75, "90th_percentile": 18.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [ { "code": "082", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18430.0, "minimum": 16058.87, "maximum": 41731.2081, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17727.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 41300.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17727.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17727.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34721.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18430.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16058.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18430.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34721.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17727.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18430.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17727.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25419.71 } ] } ] }, { "description": "HC MR ANGIO, HEAD", "code_information": [ { "code": "70544", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2406.88, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2098.7994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1468.58, "10th_percentile": 1468.58, "90th_percentile": 1468.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1453.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1476.09, "10th_percentile": 1476.09, "90th_percentile": 1476.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj 500 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009075801", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 43.31, "10th_percentile": 43.31, "90th_percentile": 159.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 51.04, "10th_percentile": 51.04, "90th_percentile": 53.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "count": "1 through 10" } ] } ] }, { "description": "HC NEG PRESS WOUND TX W DME, > 50 CM", "code_information": [ { "code": "97606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 819.69, "discounted_cash": 401.0, "minimum": 245.907, "maximum": 819.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 819.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 819.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 819.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "821", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18073.0, "minimum": 15451.18, "maximum": 40847.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17384.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 40451.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17384.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17384.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40847.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18073.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15451.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18073.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40847.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17384.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18073.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17384.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24896.99 } ] } ] }, { "description": "HC (SUP SHELL A6224) GAUZE > 48 IN NO W/SAL W/O B - A6224 - 27100088", "code_information": [ { "code": "A6224", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 4.9853, "maximum": 8.6759, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARTHROGRAM OF SHOULDER", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 722.81, "discounted_cash": 344.0, "minimum": 216.843, "maximum": 722.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 388.58, "10th_percentile": 388.58, "90th_percentile": 388.58, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 722.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 722.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 722.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 449.53, "10th_percentile": 449.53, "90th_percentile": 449.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 722.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 504.23, "10th_percentile": 504.23, "90th_percentile": 504.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hydroxyzine HCl Tab 25 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60687067511", "type": "NDC" }, { "code": "Q0177", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL - G0103 - 30100312", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.25, "discounted_cash": 19.0, "minimum": 18.7655, "maximum": 201.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.46, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC", "code_information": [ { "code": "353", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23118.0, "minimum": 20300.26, "maximum": 109314.6656, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22226.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 52438.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22226.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22226.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 49170.43 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23118.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20300.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23118.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49170.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22226.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 23118.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22226.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32275.12 } ] } ] }, { "description": "HC CAR SEAT/BED TEST 60 MIN", "code_information": [ { "code": "94780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.44, "discounted_cash": 36.0, "minimum": 36.85, "maximum": 190.4797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.35, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.09, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT", "code_information": [ { "code": "124", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11110.0, "minimum": 9024.72, "maximum": 28613.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10703.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23908.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10703.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10703.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28613.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11110.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9024.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11110.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28613.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10703.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11110.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10703.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14715.09 } ] } ] }, { "description": "HC (SUP SHELL A4626) TRACHEOSTOMY CLEANING BRUSH", "code_information": [ { "code": "A4626", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.412, "maximum": 7.678, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Epoetin Alfa-epbx Inj 2000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00069130501", "type": "NDC" }, { "code": "Q5106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.6286, "maximum": 31.0559, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG", "code_information": [ { "code": "96158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.13, "discounted_cash": 175.0, "minimum": 101.439, "maximum": 338.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 338.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 338.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.89, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 296.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [ { "code": "125", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6887.0, "minimum": 5714.94, "maximum": 13874.0232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6651.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13874.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6651.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6651.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13192.25 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6887.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5714.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6887.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13192.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6651.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6887.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6651.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8539.23 } ] } ] }, { "description": "Palonosetron HCl IV Soln 0.25 MG/5ML (Base Equivalent)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "60505619301", "type": "NDC" }, { "code": "J2469", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.075, "maximum": 1.075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 55.26, "10th_percentile": 55.26, "90th_percentile": 55.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 68.04, "10th_percentile": 20.52, "90th_percentile": 68.04, "count": "1 through 10" } ] } ] }, { "description": "HC DRUG SCREEN PRSMV QUAL DIR OPTICAL OBS PER DAY", "code_information": [ { "code": "80305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.38, "discounted_cash": 12.0, "minimum": 12.2447, "maximum": 152.0594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERCUT MITRAL VALVULOPLASTY", "code_information": [ { "code": "92987", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22195.3, "discounted_cash": 11390.0, "minimum": 6658.59, "maximum": 22195.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22195.3, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22195.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22195.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prednisone Tab 1 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "59651048401", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC URINALYSIS, AUTO, W/O SCOPE", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.13, "discounted_cash": 2.0, "minimum": 2.1865, "maximum": 55.0494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 40.4, "10th_percentile": 33.94, "90th_percentile": 51.8, "count": "38" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 32.17, "10th_percentile": 32.17, "90th_percentile": 41.25, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 10.06, "10th_percentile": 10.06, "90th_percentile": 51.8, "count": "13" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.46, "10th_percentile": 40.33, "90th_percentile": 56.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SPEECH/HEARING THERAPY INDIVIDUAL, 15 MIN", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.31, "discounted_cash": 73.0, "minimum": 71.369, "maximum": 397.0303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.21, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.37, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT RPT", "code_information": [ { "code": "34704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6207.5, "minimum": 1862.25, "maximum": 6207.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6207.5 } ] } ] }, { "description": "HC US, OB < 14 WKS, ADD'L FETUS", "code_information": [ { "code": "76802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 414.38, "minimum": 124.314, "maximum": 361.3394, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.26 } ] } ] }, { "description": "HC PLACE NEPROSTOMY CATH, PERQ W IMG", "code_information": [ { "code": "50432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7570.94, "discounted_cash": 2062.0, "minimum": 2062.58, "maximum": 7570.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7570.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7570.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7570.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 4040.37, "10th_percentile": 4040.37, "90th_percentile": 4040.37, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTISTREPTOLYSIN O SCREEN", "code_information": [ { "code": "86063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.0, "discounted_cash": 5.0, "minimum": 5.6073, "maximum": 100.28, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.76, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A2010) APIS, PER SQUARE CENTIMETER", "code_information": [ { "code": "A2010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fluconazole in NaCl 0.9% Inj 400 MG/200ML", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "25021018487", "type": "NDC" }, { "code": "J1450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.697, "maximum": 7.697, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.7 } ] } ] }, { "description": "HC TRANSLUM PERIPHERAL ATHERECTOMY ABDOM AORTA", "code_information": [ { "code": "0236T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33815.3, "discounted_cash": 11390.0, "minimum": 10144.59, "maximum": 33815.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33815.3, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33815.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33815.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CULTURE SPEC, BACTERIA, NOT URINE,STOOL,BLOOD", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.13, "discounted_cash": 8.0, "minimum": 8.3769, "maximum": 207.6494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 143.8, "10th_percentile": 127.6, "90th_percentile": 143.8, "count": "12" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 114.5, "10th_percentile": 91.73, "90th_percentile": 114.5, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 117.75, "10th_percentile": 102.75, "90th_percentile": 128.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 38.53, "10th_percentile": 38.53, "90th_percentile": 143.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 147.37, "10th_percentile": 45.08, "90th_percentile": 166.12, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7445.0, "minimum": 5953.73, "maximum": 26390.9986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7186.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15200.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7186.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7186.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14371.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7445.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5953.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7445.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14371.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7186.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7445.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7186.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9355.56 } ] } ] }, { "description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "470", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15718.0, "minimum": 13050.17, "maximum": 62865.7803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15124.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34854.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15124.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15124.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38133.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15718.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13050.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15718.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38133.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15124.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15718.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15124.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21452.61 } ] } ] }, { "description": "HC (SUP SHELL A4416) OST PCH CLSD W BARRIER/FILTR", "code_information": [ { "code": "A4416", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.8192, "maximum": 6.6464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND CPLX EYE/EAR/NOSE/LIP 1.1-2.5 CM", "code_information": [ { "code": "13151", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2362.81, "discounted_cash": 729.0, "minimum": 708.843, "maximum": 2362.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22275.0, "minimum": 18317.99, "maximum": 60361.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21416.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 50434.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21416.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21416.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 60361.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22275.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18317.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22275.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60361.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21416.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22275.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21416.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31041.72 } ] } ] }, { "description": "HC (SUP SHELL C1894) INTRDUCR/SHEATH NOT GUID NON-LASR", "code_information": [ { "code": "C1894", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 372.29, "10th_percentile": 299.71, "90th_percentile": 533.9, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1596.78, "10th_percentile": 1596.78, "90th_percentile": 1596.78, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 125.15, "10th_percentile": 66.12, "90th_percentile": 125.15, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 119.79, "10th_percentile": 119.79, "90th_percentile": 119.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 165.68, "10th_percentile": 133.1, "90th_percentile": 2141.63, "count": "1 through 10" } ] } ] }, { "description": "HC REPAIR MOUTH LACERATION,<2.5 CM", "code_information": [ { "code": "40830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312.5, "discounted_cash": 233.0, "minimum": 93.75, "maximum": 312.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 312.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 312.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 312.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8691) AOI SND PROC REPL EXCL ACTUA", "code_information": [ { "code": "L8691", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2069.0, "minimum": 2011.3636, "maximum": 3500.3274, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2069.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2069.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2069.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2069.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2069.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3500.33, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2069.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2069.73, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2514.1, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2069.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2011.36, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2069.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2069.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2069.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2256.01, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF RENIN", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322.81, "discounted_cash": 21.0, "minimum": 21.3699, "maximum": 281.4903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 206.6, "10th_percentile": 206.6, "90th_percentile": 206.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.71, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.37, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 164.51, "10th_percentile": 164.51, "90th_percentile": 164.51, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 173.72, "10th_percentile": 173.72, "90th_percentile": 173.72, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 98.3, "10th_percentile": 98.3, "90th_percentile": 98.3, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 225.19, "10th_percentile": 225.19, "90th_percentile": 225.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC", "code_information": [ { "code": "098", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18501.0, "minimum": 15014.44, "maximum": 43825.5812, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17795.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 41468.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17795.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17795.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37868.07 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15014.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37868.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17795.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18501.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17795.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25523.14 } ] } ] }, { "description": "HC HEPARIN ASSAY", "code_information": [ { "code": "85520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237.19, "discounted_cash": 13.0, "minimum": 12.7209, "maximum": 206.8297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECT TRIGGER POINTS, > 3", "code_information": [ { "code": "20553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1142.81, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1142.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1142.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1142.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1142.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL", "code_information": [ { "code": "34711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3269.06, "minimum": 980.718, "maximum": 3269.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 3269.06 } ] } ] }, { "description": "PLEURAL EFFUSION WITH CC", "code_information": [ { "code": "187", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8570.0, "minimum": 6949.02, "maximum": 17872.8787, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17872.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16683.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8570.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6949.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16683.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8570.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11000.45 } ] } ] }, { "description": "HC CARDIOLIPIN ANTIBODY", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 422.5, "discounted_cash": 25.0, "minimum": 24.7323, "maximum": 368.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 227.52, "10th_percentile": 227.52, "90th_percentile": 227.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 609.13, "10th_percentile": 609.13, "90th_percentile": 609.13, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 454.75, "10th_percentile": 437.07, "90th_percentile": 655.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 561.0, "10th_percentile": 561.0, "90th_percentile": 589.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Paricalcitol IV Soln 5 MCG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00074165801", "type": "NDC" }, { "code": "J2501", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7415, "maximum": 1.7415, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.74 } ] } ] }, { "description": "HC CLSD TREAT METATARSAL FX W MANIP", "code_information": [ { "code": "28475", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1758) CATHETER URETERAL", "code_information": [ { "code": "C1758", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 680.23, "10th_percentile": 680.23, "90th_percentile": 680.23, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 724.44, "10th_percentile": 724.44, "90th_percentile": 724.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 724.44, "10th_percentile": 724.44, "90th_percentile": 724.44, "count": "1 through 10" } ] } ] }, { "description": "HC REMOVE IMPACTED EAR WAX UNI", "code_information": [ { "code": "69209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.31, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 305.4703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYSTOURETHROSCOPY", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1336.56, "discounted_cash": 688.0, "minimum": 400.968, "maximum": 1336.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1336.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1336.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1336.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 749.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1163.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ,LUMB EPIDUR,BLOOD/CLOT PATCH", "code_information": [ { "code": "62273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2982.19, "discounted_cash": 696.0, "minimum": 696.49, "maximum": 2982.19, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2982.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6222) GAUZE <=16 IN NO W/SAL W/O B - A6222 - RU272010", "code_information": [ { "code": "A6222", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 2.9543, "maximum": 5.1412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.95, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ORTHOTIC MGMT AND TRAIN INITIAL ENCTR EA 15 MIN", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.06, "discounted_cash": 43.0, "minimum": 41.718, "maximum": 121.2603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.01, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.41, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVASC LITHOTR-STENT TIB/PER", "code_information": [ { "code": "C9773", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71019.1, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 71019.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEP B CORE AB TEST, IGM", "code_information": [ { "code": "86705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.06, "discounted_cash": 11.0, "minimum": 11.4381, "maximum": 125.6203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 52.61, "10th_percentile": 52.61, "90th_percentile": 52.61, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 138.54, "10th_percentile": 138.54, "90th_percentile": 138.54, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 77.53, "10th_percentile": 74.56, "90th_percentile": 77.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 95.7, "10th_percentile": 11.77, "90th_percentile": 100.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HOME SLEEP TEST/TYPE 3 PORTA - G0399 - 74000034", "code_information": [ { "code": "G0399", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1323.44, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1154.0397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 772.92, "10th_percentile": 772.92, "90th_percentile": 772.92, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine HCl Preservative Free (PF) Inj 0.25%", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "00143933301", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC", "code_information": [ { "code": "802", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31348.0, "minimum": 24811.58, "maximum": 212982.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30122.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 71992.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 30122.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 30122.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 212981.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 31348.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24811.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31348.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 212982.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30122.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 31348.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30122.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44309.89 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8389.0, "minimum": 6687.39, "maximum": 22158.8563, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8092.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17442.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8092.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8092.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18729.46 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6687.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18729.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8092.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8092.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10735.76 } ] } ] }, { "description": "HC I&D BARTHOLIN GLAND ABSCESS", "code_information": [ { "code": "56420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 683.13, "discounted_cash": 199.0, "minimum": 199.48, "maximum": 683.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 683.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 683.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 683.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 337.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CURETTE/TREAT CORNEA", "code_information": [ { "code": "65435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1164.38, "discounted_cash": 983.0, "minimum": 349.314, "maximum": 1164.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1164.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1164.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1072.15, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 983.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1164.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SURG PATH,LEVEL II", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.0, "discounted_cash": 36.0, "minimum": 36.85, "maximum": 449.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 659.2, "10th_percentile": 276.86, "90th_percentile": 659.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.35, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.09, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 524.89, "10th_percentile": 524.89, "90th_percentile": 524.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 105.22, "10th_percentile": 105.22, "90th_percentile": 105.22, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAIN FINGER ABSCESS SIMPLE", "code_information": [ { "code": "26010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 441.25, "discounted_cash": 197.0, "minimum": 132.375, "maximum": 441.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [ { "code": "576", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38323.0, "minimum": 36815.7, "maximum": 105996.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36815.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 88563.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 36815.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36815.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 105995.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 38323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37342.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 105996.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36815.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 38323.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36815.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54509.58 } ] } ] }, { "description": "HC REPR WND INTRMD FACE 2.6-5.0 CM", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6023 )COLLAGEN DRESSING >48 SQ IN", "code_information": [ { "code": "A6023", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 271.0, "minimum": 263.5716, "maximum": 458.6873, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 329.45, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 263.57, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 295.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 458.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC", "code_information": [ { "code": "641", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6966.0, "minimum": 5408.33, "maximum": 19178.0928, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 17264.68, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12050.82, "10th_percentile": 12050.82, "90th_percentile": 12050.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6727.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14061.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6727.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 16774.23, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5124.6, "10th_percentile": 5124.6, "90th_percentile": 5124.6, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6727.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11629.69 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 19134.11, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11330.64, "10th_percentile": 11330.64, "90th_percentile": 11330.64, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6966.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5408.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6966.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11629.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6727.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6966.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6727.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8654.89 } ] } ] }, { "description": "Tacrolimus Cap 0.5 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904662361", "type": "NDC" }, { "code": "J7507", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Lacosamide IV Inj 200 MG/20ML (10 MG/ML)", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "25021079120", "type": "NDC" }, { "code": "C9254", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ASSAY OF ANDROSTENEDIONE", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 421.25, "discounted_cash": 29.0, "minimum": 28.4543, "maximum": 367.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 130.88, "10th_percentile": 130.88, "90th_percentile": 130.88, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.57, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 226.7, "10th_percentile": 226.7, "90th_percentile": 226.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.92, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 293.86, "10th_percentile": 293.86, "90th_percentile": 296.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT SHLDR DISLOC,GR TUB FX, W MANIP", "code_information": [ { "code": "23665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 554.69, "discounted_cash": 1586.0, "minimum": 166.407, "maximum": 554.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 554.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ORAL SPEECH DEVICE EVAL", "code_information": [ { "code": "92597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 438.75, "discounted_cash": 68.0, "minimum": 66.6072, "maximum": 382.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66.61, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 115.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC KRAS GENE", "code_information": [ { "code": "81275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 847.19, "discounted_cash": 193.0, "minimum": 187.8004, "maximum": 847.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 234.74, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 187.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 847.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 210.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 326.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLACEMENT NG/OG TUBE BY PHYSICIAN", "code_information": [ { "code": "43752", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 673.44, "discounted_cash": 440.0, "minimum": 202.032, "maximum": 673.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 673.44, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 673.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 673.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 673.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE", "code_information": [ { "code": "78799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1329.38, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1329.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1329.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1329.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1329.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RADIOLOGIC EXAM ABDOMEN 1 VIEW", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.19, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 402.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 242.8, "10th_percentile": 203.95, "90th_percentile": 242.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 402.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 203.99, "10th_percentile": 203.99, "90th_percentile": 203.99, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 235.94, "10th_percentile": 235.94, "90th_percentile": 245.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 190.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 242.8, "10th_percentile": 242.8, "90th_percentile": 242.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 267.08, "10th_percentile": 232.66, "90th_percentile": 280.57, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US,TRANSRECTAL", "code_information": [ { "code": "76872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 780.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 780.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 780.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY IV PYELOGRAM (IVP)", "code_information": [ { "code": "74400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2031.56, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1771.5203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 982.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CESSATION THROMBOLYTIC THRPY W/CATHETER REMOVAL", "code_information": [ { "code": "37214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8061.25, "discounted_cash": 3115.0, "minimum": 2418.375, "maximum": 8061.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8061.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8061.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8061.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT", "code_information": [ { "code": "81241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.94, "discounted_cash": 73.0, "minimum": 71.301, "maximum": 384.9871, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 73.37, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 384.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 73.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 73.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 73.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 73.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX EXTREM VENOUS,BILAT", "code_information": [ { "code": "93970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2294.06, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2000.4203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L4397) STATIC OR DYNAMI AFO PRE OTS", "code_information": [ { "code": "L4397", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 210.0, "minimum": 204.3501, "maximum": 355.6255, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 255.43, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 204.35, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 355.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4310) INSERT TRAY W/O BAG/CATH", "code_information": [ { "code": "A4310", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 11.0, "minimum": 10.6995, "maximum": 18.6201, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Aztreonam For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323040101", "type": "NDC" }, { "code": "J0457", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.332, "maximum": 5.332, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.33 } ] } ] }, { "description": "Ampicillin & Sulbactam Sodium For Inj 1.5 (1-0.5) GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567021010", "type": "NDC" }, { "code": "J0295", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.3755, "maximum": 3.3755, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.38 } ] } ] }, { "description": "HC (SUP SHELL Q4117) HYALOMATRIX", "code_information": [ { "code": "Q4117", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 36.3565, "maximum": 605.4868, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BRUCELLA, ANTIBODY", "code_information": [ { "code": "86622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.5, "discounted_cash": 8.0, "minimum": 8.6782, "maximum": 106.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6532) COMPRESSION STOCKING BK40-50", "code_information": [ { "code": "A6532", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 86.0, "minimum": 84.43, "maximum": 146.9315, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.53, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US, OB >/= 14 WKS, SNGL FETUS", "code_information": [ { "code": "76805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1121.88, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 978.2794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 780.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FIBRINOLYTIC PLASMINOGEN", "code_information": [ { "code": "85415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 241.25, "discounted_cash": 17.0, "minimum": 16.7052, "maximum": 210.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.88, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOPATH C/V THIN LAYER REDO", "code_information": [ { "code": "88143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.19, "discounted_cash": 23.0, "minimum": 22.3903, "maximum": 158.8697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BPG OTH/THN VEIN FEMORAL-FEMORAL", "code_information": [ { "code": "35661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13372.2, "minimum": 4011.66, "maximum": 13372.2, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13372.2 } ] } ] }, { "description": "HC VENOGRAM SUPER VENA CAVA", "code_information": [ { "code": "75827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2807.19, "discounted_cash": 1553.0, "minimum": 579.1333, "maximum": 2807.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2807.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2807.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2807.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 579.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH - C9600 - 48100192", "code_information": [ { "code": "C9600", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27387.5, "discounted_cash": 11390.0, "minimum": 52.875, "maximum": 27387.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27387.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27387.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27387.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 15499.44, "10th_percentile": 15499.44, "90th_percentile": 15499.44, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TUMOR IMAGING, MULT AREAS", "code_information": [ { "code": "78801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2228.44, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1943.1997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1553.98, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1887.72, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1892.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MINOR SKIN DISORDERS WITHOUT MCC", "code_information": [ { "code": "607", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7941.0, "minimum": 5981.41, "maximum": 25891.6246, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7662.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16378.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7662.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7662.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8325.28 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7941.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5981.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7941.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8325.28 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7662.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7941.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7662.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10080.69 } ] } ] }, { "description": "HC X-RAY RIBS, CHEST 4+ VW", "code_information": [ { "code": "71111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 827.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 721.8503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 499.8, "10th_percentile": 499.8, "90th_percentile": 499.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MR SAFETY IMPLT ELECTRONICS PREPJ SUPVJ PHYS/QHP", "code_information": [ { "code": "76018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 344.38, "discounted_cash": 93.0, "minimum": 93.8, "maximum": 344.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 344.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 158.63, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 344.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 344.38, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "HC MODER SEDATE SAME PHYS/QHP 5/>YRS INIT 15 MIN", "code_information": [ { "code": "99152", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 665.63, "minimum": 199.689, "maximum": 580.4294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 385.8, "10th_percentile": 385.8, "90th_percentile": 385.8, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 394.34, "10th_percentile": 374.9, "90th_percentile": 428.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 388.09, "10th_percentile": 369.69, "90th_percentile": 408.21, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 397.41, "10th_percentile": 397.41, "90th_percentile": 401.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 464.34, "10th_percentile": 388.09, "90th_percentile": 471.24, "count": "1 through 10" } ] } ] }, { "description": "HC NM THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN", "code_information": [ { "code": "78014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1270.31, "discounted_cash": 394.0, "minimum": 381.093, "maximum": 1270.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1270.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1270.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1270.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1270.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cyclosporine Cap 25 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00078024061", "type": "NDC" }, { "code": "J7515", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.591, "maximum": 1.591, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.59 } ] } ] }, { "description": "HC ASSAY OF SWEAT SODIUM", "code_information": [ { "code": "84302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.5, "discounted_cash": 4.0, "minimum": 4.7229, "maximum": 76.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4174) PALINGEN OR PROMATRX", "code_information": [ { "code": "Q4174", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 626.2305, "maximum": 626.2305, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 626.23 } ] } ] }, { "description": "HC HPV TYPES 16 & 18 ONLY", "code_information": [ { "code": "87625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.56, "discounted_cash": 40.0, "minimum": 39.4065, "maximum": 332.7203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 230.4, "10th_percentile": 230.4, "90th_percentile": 230.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.41, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 194.44, "10th_percentile": 194.44, "90th_percentile": 194.44, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 205.34, "10th_percentile": 197.45, "90th_percentile": 205.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 266.18, "10th_percentile": 212.77, "90th_percentile": 268.62, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ALDOLASE", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.13, "discounted_cash": 9.0, "minimum": 9.4362, "maximum": 103.0094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 63.5, "10th_percentile": 63.5, "90th_percentile": 75.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.79, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 64.79, "10th_percentile": 64.79, "90th_percentile": 64.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 82.4, "10th_percentile": 82.4, "90th_percentile": 82.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF BARBITURATES - 80345 - 30100326", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.75, "minimum": 57.1945, "maximum": 182.03, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.19 } ] } ] }, { "description": "HC (SUP SHELL C1892) INTRDUCR/SHEATH EP CURVE PEEL-AWAY", "code_information": [ { "code": "C1892", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 318.02, "10th_percentile": 318.02, "90th_percentile": 2237.26, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 379.18, "10th_percentile": 379.18, "90th_percentile": 389.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 362.79, "10th_percentile": 362.79, "90th_percentile": 2756.31, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY TIB + FIB, 2VW", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 493.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 430.2797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 250.32, "10th_percentile": 250.32, "90th_percentile": 298.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 289.58, "10th_percentile": 289.58, "90th_percentile": 289.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 94.67, "10th_percentile": 94.67, "90th_percentile": 94.67, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 327.8, "10th_percentile": 302.62, "90th_percentile": 605.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT PATELLR DISLOC WO ANES", "code_information": [ { "code": "27560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 510.31, "discounted_cash": 243.0, "minimum": 153.093, "maximum": 510.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 510.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 510.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 510.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEP A AB TEST, IGM", "code_information": [ { "code": "86709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.75, "discounted_cash": 11.0, "minimum": 10.9425, "maximum": 199.47, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 50.33, "10th_percentile": 50.33, "90th_percentile": 50.33, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 110.04, "10th_percentile": 110.04, "90th_percentile": 110.04, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 118.44, "10th_percentile": 118.44, "90th_percentile": 123.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 152.02, "10th_percentile": 11.26, "90th_percentile": 159.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781320990", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0535, "maximum": 1.0535, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 15.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.84, "90th_percentile": 14.84, "count": "1 through 10" } ] } ] }, { "description": "Lidocaine Inj 1% w/ Epinephrine-1:200000 (PF)", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "63323048707", "type": "NDC" }, { "code": "J2004", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.84, "90th_percentile": 14.84, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6453) SELF-ADHER BAND W <3/YD - A6453 - 27100096", "code_information": [ { "code": "A6453", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.5221, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.09, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBIOTIC SENS,ENZYME DETECTION,EACH", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.75, "discounted_cash": 4.0, "minimum": 4.6161, "maximum": 33.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 21.23, "10th_percentile": 21.23, "90th_percentile": 21.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.62, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARC BLOOD TYPING, RH PHENOTYPE", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 674.69, "discounted_cash": 36.0, "minimum": 36.85, "maximum": 588.3297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.09, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2168.75, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1891.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1099.9, "10th_percentile": 1018.42, "90th_percentile": 1929.98, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1225.28, "10th_percentile": 1178.15, "90th_percentile": 2321.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 754.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 336.23, "10th_percentile": 336.23, "90th_percentile": 336.23, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1327.29, "10th_percentile": 1166.77, "90th_percentile": 1512.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERCUTANEOUS TRANSCATHETER SEPTAL REDUCTION THER", "code_information": [ { "code": "93583", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13958.8, "minimum": 4187.64, "maximum": 13958.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13958.8 } ] } ] }, { "description": "HC FIBRIN DEGRADPRODUCTS,D-DIMER, ULTRASENS", "code_information": [ { "code": "85380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.19, "discounted_cash": 10.0, "minimum": 9.8929, "maximum": 163.2297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 94.92, "10th_percentile": 94.92, "90th_percentile": 94.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 95.39, "10th_percentile": 95.39, "90th_percentile": 95.39, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 100.74, "10th_percentile": 96.84, "90th_percentile": 100.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 45.5, "10th_percentile": 45.5, "90th_percentile": 45.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 124.3, "10th_percentile": 53.24, "90th_percentile": 130.58, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8340.0, "minimum": 6261.73, "maximum": 26357.0504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 23727.39, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 20505.34, "10th_percentile": 15569.19, "90th_percentile": 24255.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8045.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17325.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8045.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 22427.67, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 14849.36, "10th_percentile": 14849.36, "90th_percentile": 14849.36, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 23053.35, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16920.87, "10th_percentile": 16920.87, "90th_percentile": 16920.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 23125.89, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 23718.03, "10th_percentile": 20382.31, "90th_percentile": 28953.17, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8045.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22881.38 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 26296.6, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 20515.03, "10th_percentile": 20515.03, "90th_percentile": 20515.03, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8340.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6261.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8340.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22881.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 26357.05, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 21344.8, "10th_percentile": 20624.66, "90th_percentile": 24055.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8045.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8340.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8045.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10663.47 } ] } ] }, { "description": "HC CATH PLC/COR ANG RS/I BYPS ANG R&L CTH L VNTRIC", "code_information": [ { "code": "93461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [ { "code": "273", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32424.0, "minimum": 27064.48, "maximum": 121947.3238, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31154.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 74547.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31154.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 106997.59, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 52507.27, "10th_percentile": 52507.27, "90th_percentile": 52507.27, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31154.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 67013.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32424.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27064.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32424.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67013.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31154.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 32424.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31154.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45882.49 } ] } ] }, { "description": "HC MRI CHEST W/CONTRAST", "code_information": [ { "code": "71551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2698.75, "discounted_cash": 773.0, "minimum": 773.49, "maximum": 2698.75, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2698.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2698.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2698.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2661.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "507", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14786.0, "minimum": 13414.92, "maximum": 39066.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32641.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39066.3 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14786.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13414.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14786.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39066.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14786.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20090.2 } ] } ] }, { "description": "HC HEMODIALYSIS W SING EVAL - 90935 - 80100001", "code_information": [ { "code": "90935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3368.75, "discounted_cash": 677.0, "minimum": 677.19, "maximum": 3240.8282, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2667.86, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3240.83, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2592.76, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 738.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1145.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "947", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10702.0, "minimum": 8902.21, "maximum": 39156.1553, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22937.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17490.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10702.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8902.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10702.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17490.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10702.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14117.86 } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "270", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41176.0, "minimum": 8738.34, "maximum": 128097.6421, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 95341.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 39553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 112393.93, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 187151.84, "10th_percentile": 187151.84, "90th_percentile": 187151.84, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 39553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8738.34 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 41176.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35527.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41176.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8738.34 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 41176.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58681.32 } ] } ] }, { "description": "HC (SUP SHELL L0633) LSO SC R POS/LAT PNL PRE CST", "code_information": [ { "code": "L0633", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 343.0, "minimum": 334.27, "maximum": 581.7221, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 343.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 417.82, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 334.27, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 343.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 343.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 374.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 343.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 343.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 581.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INCISION & DRAIN SKIN ABSCESS COMPLIC", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PRQ DRUG ELUTING COR STENT ATHER S - C9602 - 48100194", "code_information": [ { "code": "C9602", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27935.9, "discounted_cash": 18087.0, "minimum": 8380.77, "maximum": 27935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TESTES PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "712", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9411.0, "minimum": 6132.99, "maximum": 21566.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9073.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19871.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9073.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9073.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21566.25 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9411.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6132.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9411.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21566.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9073.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9411.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9073.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12230.51 } ] } ] }, { "description": "HC LYME DISEASE ANTIBODY", "code_information": [ { "code": "86618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.13, "discounted_cash": 17.0, "minimum": 16.5498, "maximum": 264.3294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 183.0, "10th_percentile": 183.0, "90th_percentile": 183.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 154.47, "10th_percentile": 145.71, "90th_percentile": 154.47, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 163.13, "10th_percentile": 156.83, "90th_percentile": 163.13, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 76.12, "10th_percentile": 43.5, "90th_percentile": 76.12, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 201.3, "10th_percentile": 89.36, "90th_percentile": 211.46, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ADP & AMP", "code_information": [ { "code": "82030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 399.69, "discounted_cash": 25.0, "minimum": 25.0724, "maximum": 348.5297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.07, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD CLOT FACTOR XI TEST", "code_information": [ { "code": "85270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 333.44, "discounted_cash": 17.0, "minimum": 17.3952, "maximum": 290.7597, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.74, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6436.0, "minimum": 4565.31, "maximum": 12802.4816, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6218.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12802.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6218.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6218.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9751.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6436.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4565.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6436.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9751.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6218.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6436.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6218.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7879.71 } ] } ] }, { "description": "HC CLSD TREAT TEMPOROMANDIBL DISLOC", "code_information": [ { "code": "21480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 591.56, "discounted_cash": 243.0, "minimum": 177.468, "maximum": 591.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US FETAL HEART DOPPLER", "code_information": [ { "code": "76827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 818.44, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 713.6797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 374.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EXCISION OF NAIL FOLD (WEDGE), TOE", "code_information": [ { "code": "11765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.0, "discounted_cash": 401.0, "minimum": 114.0, "maximum": 380.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 380.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLACE BILE CATH, CHOLANGIO, PERQ INTER-EXTERNAL", "code_information": [ { "code": "47534", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12314.1, "discounted_cash": 3532.0, "minimum": 3532.78, "maximum": 12314.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12314.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12314.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12314.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OCCUP THRP EVAL, HIGH COMPLEXITY, 60 MIN", "code_information": [ { "code": "97167", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 626.88, "discounted_cash": 96.0, "minimum": 93.8079, "maximum": 546.6394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.53, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.25, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.81, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 96.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 96.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 96.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM TEAR FLOW EXAM", "code_information": [ { "code": "78660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.5, "discounted_cash": 394.0, "minimum": 371.25, "maximum": 1237.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 982.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEART FIRST PASS SINGLE,PLANAR", "code_information": [ { "code": "78481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.38, "discounted_cash": 535.0, "minimum": 125.814, "maximum": 419.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 419.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION ANDOR D&C", "code_information": [ { "code": "768", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9197.0, "minimum": 6998.85, "maximum": 19363.6405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 16671.82, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8401.78, "10th_percentile": 8401.78, "90th_percentile": 8401.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8868.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19363.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8868.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 16198.21, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5208.68, "10th_percentile": 5208.68, "90th_percentile": 9495.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 16249.18, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 10886.6, "10th_percentile": 10886.6, "90th_percentile": 18268.3, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8868.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11633.58 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9197.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6998.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9197.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11633.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 18519.52, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11792.79, "10th_percentile": 11792.79, "90th_percentile": 11792.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8868.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9197.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8868.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11917.99 } ] } ] }, { "description": "HC TRIM BENIGN HYPERKERATOTIC SKIN LESION, SINGLE", "code_information": [ { "code": "11055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 441.25, "discounted_cash": 197.0, "minimum": 132.375, "maximum": 441.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PARATHYROID PLANAR IMAGING W/WO SUBTRACTION", "code_information": [ { "code": "78071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1755.0, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1755.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1755.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1755.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1553.98, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "HC TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE", "code_information": [ { "code": "37218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36140.6, "minimum": 10842.18, "maximum": 31514.6032, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15315.75 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12409.0, "minimum": 9919.65, "maximum": 35206.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11950.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26994.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11950.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11950.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 35206.62 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12409.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9919.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12409.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35206.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11950.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12409.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11950.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16614.68 } ] } ] }, { "description": "HC REVSC EVASC TPVT ST PLMT UNI CPLX LES 1ST VSL", "code_information": [ { "code": "37286", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY FOR CALPROTECTIN FECAL", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 462.5, "discounted_cash": 19.0, "minimum": 19.0764, "maximum": 403.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 248.64, "10th_percentile": 248.64, "90th_percentile": 296.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 235.69, "10th_percentile": 235.69, "90th_percentile": 235.69, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 253.67, "10th_percentile": 248.9, "90th_percentile": 253.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 87.75, "10th_percentile": 87.75, "90th_percentile": 87.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 103.0, "10th_percentile": 102.66, "90th_percentile": 325.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR", "code_information": [ { "code": "94626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.56, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 261.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 261.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Piperacillin Sod-Tazobactam Sod For Inj 4.5 GM (4-0.5 GM)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505615900", "type": "NDC" }, { "code": "J2543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.408, "maximum": 2.408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 72.41, "10th_percentile": 72.41, "90th_percentile": 72.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.41 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 85.34, "10th_percentile": 85.34, "90th_percentile": 170.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 99.93, "10th_percentile": 99.93, "90th_percentile": 99.93, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF PROCAINAMIDE W METABOLITES", "code_information": [ { "code": "80192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.94, "discounted_cash": 16.0, "minimum": 16.2777, "maximum": 183.9397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF HALOPERIDOL", "code_information": [ { "code": "80173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 602.19, "discounted_cash": 15.0, "minimum": 15.335, "maximum": 525.1097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Azithromycin For Susp 100 MG/5ML", "drug_information": { "unit": 15.0, "type": "ML" }, "code_information": [ { "code": "42806014731", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.1585, "maximum": 54.1585, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.16 } ] } ] }, { "description": "HC US BONE DENSITY MEASURE,PERIPHERAL", "code_information": [ { "code": "76977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.13, "discounted_cash": 103.0, "minimum": 40.9467, "maximum": 303.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 303.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 303.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 303.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARTHROGRAM OF ANKLE", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1090.63, "discounted_cash": 344.0, "minimum": 327.189, "maximum": 1090.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 886.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM - 93724 - 48193724", "code_information": [ { "code": "93724", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.25, "discounted_cash": 303.0, "minimum": 52.875, "maximum": 176.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7993.0, "minimum": 6411.92, "maximum": 20591.9951, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7712.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16501.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7712.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7712.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18152.75 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7993.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6411.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7993.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18152.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7712.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7993.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7712.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10156.32 } ] } ] }, { "description": "HC ASSAY OF OSTEOCALCIN", "code_information": [ { "code": "83937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450.94, "discounted_cash": 29.0, "minimum": 29.0082, "maximum": 393.2197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.48, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVASC LITHOTRIP-STENT-ATHER", "code_information": [ { "code": "C9767", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71019.1, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 71019.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CCMCC", "code_information": [ { "code": "729", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9099.0, "minimum": 7619.69, "maximum": 22897.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8774.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19130.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8774.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8774.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22896.97 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9099.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7619.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9099.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22897.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8774.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9099.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8774.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11774.52 } ] } ] }, { "description": "HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY", "code_information": [ { "code": "33017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4845.31, "minimum": 1453.593, "maximum": 4845.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 4845.31 } ] } ] }, { "description": "HC BILIRUBIN TOTAL TRANSCUTANEOUS", "code_information": [ { "code": "88720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.06, "discounted_cash": 5.0, "minimum": 4.8784, "maximum": 34.0603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 26.34, "10th_percentile": 26.34, "90th_percentile": 26.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Pantoprazole Sodium For IV Soln 40 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "70095002401", "type": "NDC" }, { "code": "J2470", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.976, "maximum": 9.976, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.98 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 36.9, "10th_percentile": 13.0, "90th_percentile": 41.26, "count": "1 through 10" } ] } ] }, { "description": "HC FUNGUS, ANTIBODY", "code_information": [ { "code": "86671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.75, "discounted_cash": 12.0, "minimum": 11.9046, "maximum": 160.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.9, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INC/DRAIN PERITONSIL ABSCESS", "code_information": [ { "code": "42700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 480.0, "discounted_cash": 233.0, "minimum": 144.0, "maximum": 480.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ENDOMETRIAL BIOPSY", "code_information": [ { "code": "58100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 724.69, "discounted_cash": 199.0, "minimum": 199.48, "maximum": 724.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 724.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 724.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 724.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 337.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF LEAD", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.94, "discounted_cash": 12.0, "minimum": 11.7685, "maximum": 131.6197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 96.6, "10th_percentile": 81.14, "90th_percentile": 96.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 76.92, "10th_percentile": 76.92, "90th_percentile": 76.92, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 72.67, "10th_percentile": 71.31, "90th_percentile": 82.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 54.13, "10th_percentile": 54.13, "90th_percentile": 54.13, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 105.29, "10th_percentile": 63.54, "90th_percentile": 106.26, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRA CHEST W CONTRAST, EXCLUDE HEART - 71555 - 61800004", "code_information": [ { "code": "71555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.94, "minimum": 900.0, "maximum": 3270.8197, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2278.63 } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITHOUT CCMCC", "code_information": [ { "code": "293", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5352.0, "minimum": 3797.73, "maximum": 15086.6518, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5178.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 10227.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5178.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5178.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 7045.22 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5352.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3797.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5352.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7045.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5178.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5352.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5178.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6294.87 } ] } ] }, { "description": "HC ASSAY FOR COLLAGEN CROSS LINKS", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.13, "discounted_cash": 18.0, "minimum": 18.1532, "maximum": 273.0494, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 98.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.59, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.69, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS", "code_information": [ { "code": "0201T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25034.1, "discounted_cash": 7159.0, "minimum": 7159.72, "maximum": 25034.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25034.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25034.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25034.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12108.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HIV WITH OR WITHOUT OTHER RELATED CONDITION", "code_information": [ { "code": "977", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10917.0, "minimum": 9979.87, "maximum": 28064.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10518.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23449.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10518.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10518.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28063.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10917.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9979.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10917.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28064.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10518.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10917.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10518.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14432.6 } ] } ] }, { "description": "HC (SUP SHELL A4617) MOUTH PIECE", "code_information": [ { "code": "A4617", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.2954, "maximum": 7.4751, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.3, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4605) TRACH SUCTION CATH CLOSE SYS", "code_information": [ { "code": "A4605", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "minimum": 22.7207, "maximum": 39.5403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.72, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10204.0, "minimum": 8346.43, "maximum": 31860.8451, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21756.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19004.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10204.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8346.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10204.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19004.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 31860.85, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 20285.06, "10th_percentile": 20285.06, "90th_percentile": 20285.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10204.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13390.5 } ] } ] }, { "description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "494", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16308.0, "minimum": 13049.48, "maximum": 51490.7249, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15690.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36257.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15690.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15690.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41131.55 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16308.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13049.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41131.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15690.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16308.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15690.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22315.65 } ] } ] }, { "description": "MOUTH PROCEDURES WITH CCMCC", "code_information": [ { "code": "137", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12404.0, "minimum": 9680.17, "maximum": 26981.8851, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26981.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22203.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12404.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9680.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12404.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22203.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12404.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16606.89 } ] } ] }, { "description": "HC ANGIO AORTOGRAM THOR SERIAL", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8332.81, "discounted_cash": 5490.0, "minimum": 599.6067, "maximum": 8332.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8332.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8332.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8332.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 599.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8332.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC", "code_information": [ { "code": "068", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7622.0, "minimum": 6101.15, "maximum": 22627.6778, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15619.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21014.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7622.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6101.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7622.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21014.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7622.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9613.58 } ] } ] }, { "description": "HC REMOVE,OBST MATL,CVA DEV VIA LUMEN", "code_information": [ { "code": "75902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1305.94, "minimum": 391.782, "maximum": 1138.7797, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 614.27 } ] } ] }, { "description": "NORMAL NEWBORN", "code_information": [ { "code": "795", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2567.0, "minimum": 1382.88, "maximum": 4705.5015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 4236.03, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 2703.43, "10th_percentile": 1100.92, "90th_percentile": 6423.13, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 2506.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 3610.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 2506.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 4003.99, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 2773.26, "10th_percentile": 1295.89, "90th_percentile": 4427.28, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 4115.69, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 3752.79, "10th_percentile": 1584.79, "90th_percentile": 5162.23, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 4128.65, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 2696.94, "10th_percentile": 1226.84, "90th_percentile": 8078.77, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 2506.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 2641.95 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 4694.71, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 3871.19, "10th_percentile": 3871.19, "90th_percentile": 3871.19, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 2567.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1382.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 2567.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2641.95 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 4705.5, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 3990.1, "10th_percentile": 1395.7, "90th_percentile": 8762.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 2506.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 2567.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 2506.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2222.11 } ] } ] }, { "description": "OTHER MENTAL DISORDER DIAGNOSES", "code_information": [ { "code": "887", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9192.0, "minimum": 8232.23, "maximum": 19350.9917, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8232.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9192.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19275.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9192.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11910.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19350.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19274.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9192.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC TRACHEOTOMY ER TRANSTRACHEAL", "code_information": [ { "code": "31603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2970.0, "discounted_cash": 1530.0, "minimum": 891.0, "maximum": 2970.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2970.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2970.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2970.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2589.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Meningococcal Vac B (Recomb OMV Adjuv) Inj Prefilled Syringe", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "58160097602", "type": "NDC" }, { "code": "90620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 519.741, "maximum": 519.741, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 519.74 } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "664", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9010.0, "minimum": 7473.65, "maximum": 20392.6051, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8688.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18917.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8688.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8688.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18957.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7473.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18957.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8688.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8688.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11643.29 } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "464", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24736.0, "minimum": 20408.23, "maximum": 104482.5464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23778.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 56282.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23778.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23778.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 70115.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24736.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20408.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24736.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 70115.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 104482.55, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 100142.07, "10th_percentile": 100142.07, "90th_percentile": 100142.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23778.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24736.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23778.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34640.7 } ] } ] }, { "description": "HC NM BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLW", "code_information": [ { "code": "78606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.19, "discounted_cash": 535.0, "minimum": 525.657, "maximum": 1752.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1752.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1752.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1752.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1752.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Phentolamine Mesylate For Inj 5 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68094010120", "type": "NDC" }, { "code": "J2760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 257.0, "minimum": 257.449, "maximum": 1014.2461, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1014.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 524.77, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 419.84, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 966.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 435.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3901) HINGE EXT/FLEX WRIST FINGER", "code_information": [ { "code": "L3901", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1807.0, "minimum": 1756.0912, "maximum": 3056.083, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1807.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1807.05, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2195.02, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1807.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1756.09, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1807.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1807.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1807.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1969.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1807.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1807.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1807.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1807.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1807.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3056.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEBRIDEMENT OPEN WOUND 20 SQ CM<", "code_information": [ { "code": "97597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.94, "discounted_cash": 197.0, "minimum": 72.282, "maximum": 240.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 240.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 240.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 240.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 240.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1769) GUIDE WIRE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 245.95, "10th_percentile": 110.54, "90th_percentile": 1019.59, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 145.76, "10th_percentile": 111.17, "90th_percentile": 483.93, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 157.34, "10th_percentile": 26.64, "90th_percentile": 1163.12, "count": "22" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 78.89, "10th_percentile": 25.54, "90th_percentile": 498.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 191.4, "10th_percentile": 30.3, "90th_percentile": 1245.64, "count": "17" } ] } ] }, { "description": "HC FETAL CONGENITAL ABNOR ASSAY FOUR ANAL", "code_information": [ { "code": "81511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 490.31, "discounted_cash": 153.0, "minimum": 147.093, "maximum": 490.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 153.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 186.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 149.17, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 490.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 153.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 153.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 167.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 153.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 153.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 259.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO EXTREMITY UNILAT", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10259.7, "discounted_cash": 3115.0, "minimum": 605.4866, "maximum": 10259.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 6380.7, "10th_percentile": 6380.7, "90th_percentile": 6380.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 605.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 7157.16, "10th_percentile": 7157.16, "90th_percentile": 7157.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Thiamine HCl Inj 100 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "65145012901", "type": "NDC" }, { "code": "J3411", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.784, "maximum": 3.784, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.78 } ] } ] }, { "description": "HC ASSAY PHOSPHATASE ACID PROSTATIC", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.31, "discounted_cash": 9.0, "minimum": 9.3876, "maximum": 235.7103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.39, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SYPHILIS TEST, QUANTITATIVE", "code_information": [ { "code": "86593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.19, "discounted_cash": 4.0, "minimum": 4.2759, "maximum": 71.6697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 57.33, "10th_percentile": 57.33, "90th_percentile": 57.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IV INFU, HYDRATION, EA ADD HOUR", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.0, "discounted_cash": 46.0, "minimum": 46.2, "maximum": 353.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 259.2, "10th_percentile": 217.73, "90th_percentile": 435.46, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 239.4, "10th_percentile": 239.4, "90th_percentile": 239.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 196.44, "10th_percentile": 196.44, "90th_percentile": 196.44, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 254.34, "10th_percentile": 172.96, "90th_percentile": 1397.1, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 282.53, "10th_percentile": 282.53, "90th_percentile": 282.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3760) EO WITHJOINT, PREFABRICATED", "code_information": [ { "code": "L3760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 545.0, "minimum": 530.5056, "maximum": 923.2261, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 545.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 545.9, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 663.1, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 545.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 530.51, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 545.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 545.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 545.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 595.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 545.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 545.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 545.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 545.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 545.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 923.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ROTAVIRUS AG, EIA", "code_information": [ { "code": "87425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360.31, "discounted_cash": 11.0, "minimum": 11.6422, "maximum": 314.1903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT 2 TRANSVEN ELECTROD/PM/DEFIB", "code_information": [ { "code": "33217", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16404.7, "discounted_cash": 8165.0, "minimum": 4921.41, "maximum": 16404.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16404.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16404.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16404.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOPATH TBS C/V REDO", "code_information": [ { "code": "88165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.38, "discounted_cash": 42.0, "minimum": 37.314, "maximum": 124.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4049) FINGER SPLINT, STATIC", "code_information": [ { "code": "Q4049", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.6044, "maximum": 4.5324, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.92, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM MYOCARDIAL SPECT MULTIPLE STUDIES", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4980.31, "discounted_cash": 1277.0, "minimum": 1277.43, "maximum": 4980.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2677.42, "10th_percentile": 2677.42, "90th_percentile": 2677.42, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4980.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4980.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4890.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 3039.98, "10th_percentile": 3039.98, "90th_percentile": 3039.98, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3150.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1371.57, "10th_percentile": 1371.57, "90th_percentile": 1371.57, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1392.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2160.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DECALCIFY TISSUE", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "minimum": 42.0, "maximum": 122.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 75.26, "10th_percentile": 75.26, "90th_percentile": 75.26, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 76.79, "10th_percentile": 76.79, "90th_percentile": 76.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.17, "10th_percentile": 56.17, "90th_percentile": 56.17, "count": "1 through 10" } ] } ] }, { "description": "HC C1-C2 PUNCT W MED INJ", "code_information": [ { "code": "61055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1101.56, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1101.56, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1101.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1101.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1101.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TALUS FX WO MANIP", "code_information": [ { "code": "28430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT RADIOULNA DISLOC W MANIP", "code_information": [ { "code": "25675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 719.69, "discounted_cash": 243.0, "minimum": 215.907, "maximum": 719.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 719.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 719.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 719.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRA PELVIS W CONTRAST - 72198 - 61800007", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2630.0, "minimum": 789.0, "maximum": 2319.5796, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2319.58 } ] } ] }, { "description": "HC CLSD TREAT A-C JT DISLOC W MANIP", "code_information": [ { "code": "23545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.94, "discounted_cash": 243.0, "minimum": 90.282, "maximum": 300.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD NECK/HND/FT/GENT 20.1-30 CM", "code_information": [ { "code": "12046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1793.44, "discounted_cash": 729.0, "minimum": 538.032, "maximum": 1793.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1793.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1793.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1793.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOPATH,OTHR SOURC,PREP,SCRN,INTERP", "code_information": [ { "code": "88161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.56, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 141.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MULTIPLE SLEEP LATENCY TEST", "code_information": [ { "code": "95805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3722.19, "discounted_cash": 847.0, "minimum": 847.32, "maximum": 3722.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3338.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3722.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3244.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 923.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1432.99, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRAUMATIC INJURY WITHOUT MCC", "code_information": [ { "code": "914", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7782.0, "minimum": 6342.71, "maximum": 16075.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7510.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16000.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7510.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7510.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16075.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7782.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6342.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7782.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16075.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7510.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7782.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7510.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9848.25 } ] } ] }, { "description": "HC FRACTURE ASSESSMENT VIA DXA", "code_information": [ { "code": "77086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.38, "discounted_cash": 85.0, "minimum": 79.314, "maximum": 264.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 264.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 264.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CITRATE", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 561.25, "discounted_cash": 27.0, "minimum": 27.016, "maximum": 489.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.77, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.02, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PRQ DRUG ELUTING COR STENT ATHER S - 92933 - 48100194", "code_information": [ { "code": "92933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27935.9, "discounted_cash": 18087.0, "minimum": 8380.77, "maximum": 27935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43052.0, "minimum": 41353.4, "maximum": 119443.4, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41353.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 43052.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41353.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61425.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41353.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 99799.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 41353.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 41353.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 119443.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 43052.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41464.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43052.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 119443.0 } ] } ] }, { "description": "HC BONE BIOPSY,TROCAR/NEEDLE DEEP", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2971.25, "discounted_cash": 1629.0, "minimum": 891.375, "maximum": 2971.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2971.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2971.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2971.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ampicillin Sodium For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781340880", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.29, "maximum": 1.29, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.29 } ] } ] }, { "description": "HC INJ W FLUOR EVAL CV DEVICE", "code_information": [ { "code": "36598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.56, "discounted_cash": 209.0, "minimum": 64.968, "maximum": 216.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 216.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 216.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4358) URINARY LEG OR ABDOMEN BAG - A4358 - RU272031", "code_information": [ { "code": "A4358", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.1923, "maximum": 14.2568, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REM PAC CVDFB PLSE GEN &REPL PLSE GEN DUAL LEAD", "code_information": [ { "code": "33263", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118780.0, "discounted_cash": 21947.0, "minimum": 21947.8, "maximum": 105035.5865, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86465.55, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105035.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84031.54, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23923.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37118.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2567.19, "discounted_cash": 894.0, "minimum": 770.157, "maximum": 2567.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1380.12, "10th_percentile": 1380.12, "90th_percentile": 1380.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2567.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2567.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2567.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF NUCLEOTIDASE 5'", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.25, "discounted_cash": 11.0, "minimum": 10.8356, "maximum": 127.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prednisone Tab 50 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60687085411", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CYTOPATH,OTHR SOURC,SCREEN,INTERP", "code_information": [ { "code": "88160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.19, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 172.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO EA ADDNL SELECTV VESSEL", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3070.0, "minimum": 447.5089, "maximum": 2677.04, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 447.51 } ] } ] }, { "description": "Human Papillomavirus (HPV) 9-Valent Recomb Vac IM Susp", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00006412101", "type": "NDC" }, { "code": "90649", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 350.966, "maximum": 350.966, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 350.97 } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CCMCC", "code_information": [ { "code": "498", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23991.0, "minimum": 17475.67, "maximum": 193496.5646, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23063.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 54513.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23063.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23063.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56829.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17475.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56829.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23063.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 23991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23063.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33551.88 } ] } ] }, { "description": "HC PLATELETS LEUKOREDUCED IRRAD", "code_information": [ { "code": "P9033", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4606.56, "discounted_cash": 188.0, "minimum": 188.66, "maximum": 4016.9203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 743.24, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 902.87, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 722.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 205.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT INTRVAS VC FILTR W VASC ACS VSSL RS&I", "code_information": [ { "code": "37191", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14944.7, "discounted_cash": 5490.0, "minimum": 4483.41, "maximum": 14944.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14944.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14944.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14944.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PHENOTYPE DNA HIV W/CLT, EA ADD", "code_information": [ { "code": "87904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.31, "discounted_cash": 26.0, "minimum": 25.3348, "maximum": 130.31, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.09, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.31 } ] } ] }, { "description": "HC ASPERGILLUS AG EIA", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.63, "discounted_cash": 11.0, "minimum": 11.6422, "maximum": 458.3494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MR ANGIO, NECK", "code_information": [ { "code": "70547", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1905.31, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1661.4303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1456.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 584.25, "10th_percentile": 584.25, "90th_percentile": 584.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT SHLDR DISLOC W MANIP WO ANES", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.69, "discounted_cash": 243.0, "minimum": 125.907, "maximum": 419.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 214.87, "10th_percentile": 214.87, "90th_percentile": 214.87, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 256.18, "10th_percentile": 256.18, "90th_percentile": 256.18, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION", "code_information": [ { "code": "87522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 593.13, "discounted_cash": 42.0, "minimum": 41.6319, "maximum": 517.2094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 300.89, "10th_percentile": 300.89, "90th_percentile": 300.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.04, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 306.98, "10th_percentile": 306.98, "90th_percentile": 319.2, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 224.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 413.76, "10th_percentile": 413.76, "90th_percentile": 413.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4410) OST SKN BARR EXTND >4 SQ", "code_information": [ { "code": "A4410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 12.0, "minimum": 12.5168, "maximum": 21.7827, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAIN EXT EAR ABSC/BLOOD,SIMPLE", "code_information": [ { "code": "69000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.63, "discounted_cash": 698.0, "minimum": 114.189, "maximum": 380.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 380.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE", "code_information": [ { "code": "78299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1339.06, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1339.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1339.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1339.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1339.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC WHIRLPOOL THERAPY", "code_information": [ { "code": "97022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.44, "discounted_cash": 14.0, "minimum": 14.3826, "maximum": 133.7997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LUNG TRANSPLANT", "code_information": [ { "code": "007", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 99539.0, "minimum": 90453.48, "maximum": 276509.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 95555.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 234008.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 95555.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 95555.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 276509.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 99539.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90453.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 99539.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 276509.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 95555.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 99539.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 95555.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 144027.98 } ] } ] }, { "description": "HC PROTOZOA, NOT ELSEWHERE", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.94, "discounted_cash": 12.0, "minimum": 12.0406, "maximum": 122.8997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVASC LITHOTRIP TIBI/PERONE", "code_information": [ { "code": "C9772", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43887.8, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 43887.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43887.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43887.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DILAT URETHRAL STRIX DILATOR MALE 1ST", "code_information": [ { "code": "53600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1350.31, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1179.8186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3927) FO PIP DIP NO JT SPR PRE OTS", "code_information": [ { "code": "L3927", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 38.0, "minimum": 37.0742, "maximum": 64.5193, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 55.35, "10th_percentile": 55.35, "90th_percentile": 55.35, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.34, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.07, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 57.02, "10th_percentile": 57.02, "90th_percentile": 57.02, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY", "code_information": [ { "code": "74248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.69, "minimum": 353.907, "maximum": 1028.6897, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 435.82 } ] } ] }, { "description": "HC TOXOPLASMA", "code_information": [ { "code": "86777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.75, "discounted_cash": 14.0, "minimum": 13.9842, "maximum": 120.99, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 64.32, "10th_percentile": 64.32, "90th_percentile": 64.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4629) TRACHEOSTOMY CARE KIT - A4629 - 27200094", "code_information": [ { "code": "A4629", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.443, "maximum": 11.2127, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT TUNNELED CV CATH W/O PORT OR PUMP", "code_information": [ { "code": "36558", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8538.44, "discounted_cash": 3115.0, "minimum": 2561.532, "maximum": 8538.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8538.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8538.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8538.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 3665.11, "10th_percentile": 3665.11, "90th_percentile": 3665.11, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PRQ TRLUML PULMONARY ART BALLOON ANGIOP 1 VSL", "code_information": [ { "code": "92997", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21027.2, "discounted_cash": 11390.0, "minimum": 6308.16, "maximum": 21027.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21027.2, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21027.2, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21027.2, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC FPVT ATHRC UNI SF LES 1ST VSL", "code_information": [ { "code": "37271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY RIBS, CHEST 3+ VW", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 773.75, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 674.71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 467.2, "10th_percentile": 392.45, "90th_percentile": 467.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 454.0, "10th_percentile": 454.0, "90th_percentile": 454.0, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 115.77, "10th_percentile": 115.77, "90th_percentile": 115.77, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 539.77, "10th_percentile": 513.92, "90th_percentile": 539.77, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND SMP BODY/SCALP/EXTR 7.6-12.5 CM", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 497.5, "discounted_cash": 197.0, "minimum": 149.25, "maximum": 497.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC TPVT ANGIOP UNI CPLX LES 1ST VSL", "code_information": [ { "code": "37282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55875.3, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 54512.3773, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44874.72, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54512.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOMEG DNA QUANT", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 766.56, "discounted_cash": 42.0, "minimum": 41.6319, "maximum": 668.4403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.04, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 224.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CCMCC", "code_information": [ { "code": "487", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12959.0, "minimum": 10937.09, "maximum": 28300.9834, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12477.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28300.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12477.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12477.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25137.57 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12959.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10937.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12959.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25137.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12477.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12959.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12477.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17418.78 } ] } ] }, { "description": "HC INSERT LV PACING ELECT TO EXISTING PM/DEFIB", "code_information": [ { "code": "33224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47866.9, "discounted_cash": 10313.0, "minimum": 10313.01, "maximum": 47866.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40629.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47866.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39485.42, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11241.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17441.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hepatitis B Vaccine (Recombinant) Susp 20 MCG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "58160082101", "type": "NDC" }, { "code": "90746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.3953, "maximum": 168.345, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.35 } ] } ] }, { "description": "HC OTHER SOURCE ALBUMIN QUAN EA", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.13, "discounted_cash": 7.0, "minimum": 7.5606, "maximum": 40.8232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS WITHOUT CCMCC", "code_information": [ { "code": "594", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7640.0, "minimum": 5874.13, "maximum": 18745.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7373.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15662.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7373.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7373.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18745.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7640.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5874.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7640.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18745.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7373.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7640.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7373.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9640.27 } ] } ] }, { "description": "HC ASSAY OF PHENOTHIAZINE - 80342 - 30100385", "code_information": [ { "code": "80342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.94, "minimum": 67.782, "maximum": 197.0197, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.46 } ] } ] }, { "description": "HC DECLOT THROMBOLYTIC AGENT IMPLANT DEV/CATH", "code_information": [ { "code": "36593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1102.5, "discounted_cash": 325.0, "minimum": 325.91, "maximum": 1102.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1102.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1102.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1102.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 653.02, "10th_percentile": 653.02, "90th_percentile": 653.02, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 643.94, "10th_percentile": 643.94, "90th_percentile": 1287.89, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 321.02, "10th_percentile": 321.02, "90th_percentile": 321.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 551.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT ANKLE DISLOC WO ANES", "code_information": [ { "code": "27840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 443.44, "discounted_cash": 243.0, "minimum": 133.032, "maximum": 443.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC PRETREATMENT,SERUM W DRUGS", "code_information": [ { "code": "86975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 896.88, "discounted_cash": 440.0, "minimum": 197.1373, "maximum": 896.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 896.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 896.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 896.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 745.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC", "code_information": [ { "code": "001", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 214180.0, "minimum": 194962.1, "maximum": 653645.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 205559.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 506387.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 205559.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 205559.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 653644.98 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 214180.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 194962.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 214180.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 653645.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 205559.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 214180.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 205559.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 311672.85 } ] } ] }, { "description": "HC MTHFR GENE", "code_information": [ { "code": "81291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.44, "discounted_cash": 65.0, "minimum": 63.4974, "maximum": 447.7197, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.37, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 110.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CARCINOEMBRYONIC ANTIGEN", "code_information": [ { "code": "82378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.25, "discounted_cash": 18.0, "minimum": 18.4253, "maximum": 258.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 189.6, "10th_percentile": 189.6, "90th_percentile": 189.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.03, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 150.97, "10th_percentile": 150.97, "90th_percentile": 150.97, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 159.43, "10th_percentile": 159.43, "90th_percentile": 162.49, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 206.66, "10th_percentile": 206.66, "90th_percentile": 208.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD FUNGUS CULTURE", "code_information": [ { "code": "87103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.06, "discounted_cash": 20.0, "minimum": 19.883, "maximum": 221.5403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC GLUCOSE TOLERANCE TEST (GTT)", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.44, "discounted_cash": 12.0, "minimum": 12.5071, "maximum": 181.7597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 133.4, "10th_percentile": 112.06, "90th_percentile": 133.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 106.22, "10th_percentile": 106.22, "90th_percentile": 212.44, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 112.17, "10th_percentile": 112.17, "90th_percentile": 112.17, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 57.53, "10th_percentile": 57.53, "90th_percentile": 57.53, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 146.74, "10th_percentile": 67.31, "90th_percentile": 146.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 329469.0, "minimum": 261022.73, "maximum": 780306.2868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 316184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 780306.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 316184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 316184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 743609.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 329469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 261022.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 329469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 743610.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 316184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 329469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 316184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 480265.28 } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC", "code_information": [ { "code": "481", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16977.0, "minimum": 14361.07, "maximum": 55715.1356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16333.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37847.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16333.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16333.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44944.47 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16977.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14361.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16977.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44944.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16333.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16977.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16333.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23294.36 } ] } ] }, { "description": "HC AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY", "code_information": [ { "code": "94728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.38, "discounted_cash": 126.0, "minimum": 82.314, "maximum": 274.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 274.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 274.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 274.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SACROILIAC JTS 3+ VW", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548.75, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 331.4, "10th_percentile": 331.4, "90th_percentile": 331.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 334.83, "10th_percentile": 334.83, "90th_percentile": 334.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 113.14, "10th_percentile": 113.14, "90th_percentile": 331.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 364.54, "10th_percentile": 364.54, "90th_percentile": 364.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER", "code_information": [ { "code": "93280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 299.38, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 261.0594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LUNG FUNCTION TEST (MBC/MVV)", "code_information": [ { "code": "94200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 290.94, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 278.5277, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4461) SURGICL DRESS HOLD NON-REUSE - A4461 - RU272032", "code_information": [ { "code": "A4461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.5675, "maximum": 7.9486, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Succinylcholine Chloride Inj 20 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "70069030101", "type": "NDC" }, { "code": "J0330", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.806, "maximum": 1.806, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 89.61, "10th_percentile": 89.61, "90th_percentile": 89.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.81 } ] } ] }, { "description": "HC RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE", "code_information": [ { "code": "45900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3070.0, "discounted_cash": 917.0, "minimum": 917.59, "maximum": 3070.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3070.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3070.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3070.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1000.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1551.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITH CC", "code_information": [ { "code": "975", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10897.0, "minimum": 9837.98, "maximum": 60092.9208, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10498.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23400.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10498.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10498.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19499.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10897.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9837.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10897.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19499.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10498.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10897.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10498.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14402.58 } ] } ] }, { "description": "HC ASPIRAT/INJECTION GANGLION CYST(S)", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1253.75, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1253.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1193.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1253.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1159.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC", "code_information": [ { "code": "059", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10485.0, "minimum": 8468.94, "maximum": 43457.6918, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10103.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22422.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10103.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10103.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27469.74 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10485.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8468.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10485.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27469.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10103.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10485.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10103.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13800.89 } ] } ] }, { "description": "HC INFECT AGENT DNA/RNA INFLUENZA FIRST 2 TYPES", "code_information": [ { "code": "87502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 479.06, "discounted_cash": 95.0, "minimum": 93.0984, "maximum": 479.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 289.2, "10th_percentile": 289.2, "90th_percentile": 289.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 479.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6204) COMPOSITE DRSG >16<=48 SQ IN - A6204 - 27200116", "code_information": [ { "code": "A6204", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.6101, "maximum": 14.984, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEMOGLOBIN CHROMOTOGRAPHY", "code_information": [ { "code": "83021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.81, "discounted_cash": 18.0, "minimum": 17.5507, "maximum": 94.7644, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 80.73, "10th_percentile": 80.73, "90th_percentile": 80.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.94, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.55, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 138.55, "10th_percentile": 138.55, "90th_percentile": 138.55, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 56.39, "10th_percentile": 56.39, "90th_percentile": 56.39, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 82.25, "10th_percentile": 71.72, "90th_percentile": 191.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1767) GENERATOR, NEURO NON-RECHARG", "code_information": [ { "code": "C1767", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 16153.4, "10th_percentile": 16153.4, "90th_percentile": 16153.4, "count": "1 through 10" } ] } ] }, { "description": "HC CLSD TREAT KNEE DISLOC W ANES", "code_information": [ { "code": "27552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7129.06, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 7129.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6250.61, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7129.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6074.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD CLOT FACTOR VIII TEST, RELATED ANTIGEN", "code_information": [ { "code": "85244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 355.0, "discounted_cash": 20.0, "minimum": 19.8442, "maximum": 309.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 91.28, "10th_percentile": 91.28, "90th_percentile": 91.28, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 247.65, "10th_percentile": 247.65, "90th_percentile": 247.65, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAIN HAND TENDON SHEATH", "code_information": [ { "code": "26020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2104.06, "discounted_cash": 3228.0, "minimum": 631.218, "maximum": 2104.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2104.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ PLCMT ACCESS BILIARY TREE & SM BWL, NEW", "code_information": [ { "code": "47541", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13264.1, "discounted_cash": 6387.0, "minimum": 3979.23, "maximum": 13264.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13264.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13264.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13264.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6962.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10802.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TISSUE CULTURE, PLACENTA", "code_information": [ { "code": "88235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1107.5, "discounted_cash": 150.0, "minimum": 146.0615, "maximum": 965.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.57, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 146.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 788.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 254.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.0, "discounted_cash": 12.0, "minimum": 12.5848, "maximum": 196.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 57.89, "10th_percentile": 57.89, "90th_percentile": 57.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.73, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 108.13, "10th_percentile": 108.13, "90th_percentile": 114.66, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 116.38, "10th_percentile": 116.38, "90th_percentile": 121.09, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 149.38, "10th_percentile": 149.38, "90th_percentile": 156.96, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC", "code_information": [ { "code": "565", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8458.0, "minimum": 7057.68, "maximum": 23034.9312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8158.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17607.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8158.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8158.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19039.24 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8458.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7057.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8458.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19039.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8158.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8458.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8158.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10836.96 } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "663", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12609.0, "minimum": 10571.64, "maximum": 44342.2093, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 39918.16, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22550.17, "10th_percentile": 22550.17, "90th_percentile": 22550.17, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27469.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32876.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12609.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10571.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12609.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32876.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12609.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12142.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16907.18 } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CCMCC", "code_information": [ { "code": "355", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11277.0, "minimum": 9227.52, "maximum": 42412.0711, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10863.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24303.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10863.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10863.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29478.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11277.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9227.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11277.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29478.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10863.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11277.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10863.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14958.66 } ] } ] }, { "description": "HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.38, "discounted_cash": 17.0, "minimum": 14.814, "maximum": 49.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7162.0, "minimum": 5658.88, "maximum": 44847.5824, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6914.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14526.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6914.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6914.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22688.5 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7162.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5658.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7162.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22688.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6914.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7162.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6914.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8940.72 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11599.0, "minimum": 9428.93, "maximum": 41232.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11172.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25068.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11172.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11172.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41232.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11599.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9428.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11599.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41232.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11172.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11599.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11172.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15429.11 } ] } ] }, { "description": "HC (SUP SHELL A6203) COMPOSITE DRSG <= 16 SQ IN - A6203 - RU272041", "code_information": [ { "code": "A6203", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.6646, "maximum": 8.1178, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC GLYCATED PROTEIN", "code_information": [ { "code": "82985", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.81, "discounted_cash": 16.0, "minimum": 16.2874, "maximum": 168.1303, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 87.94, "10th_percentile": 87.94, "90th_percentile": 134.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.34, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 74.92, "10th_percentile": 74.92, "90th_percentile": 74.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" } ] } ] }, { "description": "HC VENOGRAM HEPATIC W HEMODYNAMICS", "code_information": [ { "code": "75889", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9392.5, "discounted_cash": 3115.0, "minimum": 634.7443, "maximum": 9392.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9392.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9392.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9392.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 634.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT TUNNELED CV CATH W/O SUBQ PORT/PMP AGE < 5YR", "code_information": [ { "code": "36557", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3541.56, "discounted_cash": 5490.0, "minimum": 1062.468, "maximum": 3541.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3541.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "271", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28095.0, "minimum": 8884.46, "maximum": 100329.8918, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27001.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 64261.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27001.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27001.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8884.46 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28095.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23839.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28095.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8884.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 100329.89, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 75622.64, "10th_percentile": 75622.64, "90th_percentile": 75622.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27001.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28095.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27001.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39552.03 } ] } ] }, { "description": "HC PLACE URETERAL STNT, PERQ W IMG, NEW ACCESS", "code_information": [ { "code": "50694", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11736.6, "discounted_cash": 3478.0, "minimum": 3478.1, "maximum": 11736.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11736.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11736.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11736.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3791.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5882.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Tobramycin Sulfate For Inj 1.2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "39822041201", "type": "NDC" }, { "code": "J3260", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.44, "maximum": 3.44, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.44 } ] } ] }, { "description": "HC PERM OCCLUSION/EMBOLIZATION,PERCUT,CNS", "code_information": [ { "code": "61624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6330.0, "discounted_cash": 18087.0, "minimum": 1899.0, "maximum": 6330.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6330.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6330.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BX BREAST W DEVICE MRI GUIDE ADDL LESION", "code_information": [ { "code": "19086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5855.63, "minimum": 900.0, "maximum": 5106.1094, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "HC X-RAY FOR BILE DUCT ENDOSCOPY", "code_information": [ { "code": "74328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1932.19, "minimum": 465.0777, "maximum": 1684.8697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 979.94, "10th_percentile": 979.94, "90th_percentile": 979.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1178.94, "10th_percentile": 1178.94, "90th_percentile": 1178.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1347.89, "10th_percentile": 1347.89, "90th_percentile": 1347.89, "count": "1 through 10" } ] } ] }, { "description": "HC BODY FLUID SPECIFIC GRAVITY", "code_information": [ { "code": "84315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.19, "discounted_cash": 3.0, "minimum": 3.1875, "maximum": 45.5097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.55, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TEMPORARY EXTERNAL PACING", "code_information": [ { "code": "92953", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1295.0, "discounted_cash": 652.0, "minimum": 388.5, "maximum": 1295.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1295.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1295.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1295.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 710.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1102.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THYROID HORM UPTAKE/THYR HORM BINDING RATIO", "code_information": [ { "code": "84479", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.94, "discounted_cash": 6.0, "minimum": 6.2875, "maximum": 127.2597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 162474.0, "minimum": 148335.18, "maximum": 481017.8502, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 155944.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 383535.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 155944.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 155944.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 460702.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 162474.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148335.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 162474.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 460702.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 155944.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 162474.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 155944.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 236059.88 } ] } ] }, { "description": "HC MASTOTOMY W EXPLOR/DRAIN ABSC, DEEP", "code_information": [ { "code": "19020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 989.38, "discounted_cash": 1629.0, "minimum": 296.814, "maximum": 989.38, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 989.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC STAPH A DNA AMP PROBE", "code_information": [ { "code": "87640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.38, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 230.5394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 134.06, "10th_percentile": 134.06, "90th_percentile": 159.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 136.78, "10th_percentile": 136.78, "90th_percentile": 142.28, "count": "15" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 156.85, "10th_percentile": 156.85, "90th_percentile": 156.85, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 184.43, "10th_percentile": 175.56, "90th_percentile": 184.43, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cefepime HCl For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567024010", "type": "NDC" }, { "code": "J0692", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.58, "maximum": 2.58, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.58 } ] } ] }, { "description": "HC (SUP SHELL A7526) TRACHEOSTOMY TUBE COLLAR - A7526 - 27100102", "code_information": [ { "code": "A7526", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.6938, "maximum": 8.1685, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY TOMOGRAM", "code_information": [ { "code": "76100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 802.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 700.0503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 544.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ DX/THER AGNT PARAVERT FCT W IMG,LUMB/SAC, 2ND LVL", "code_information": [ { "code": "64494", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1861.25, "minimum": 558.375, "maximum": 1623.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1995.15, "10th_percentile": 1995.15, "90th_percentile": 1995.15, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 2992.72, "10th_percentile": 2992.72, "90th_percentile": 2992.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3523.08, "10th_percentile": 3523.08, "90th_percentile": 3523.08, "count": "1 through 10" } ] } ] }, { "description": "HC ULTRASOUND,PELVIC (NONOBSTETRIC)", "code_information": [ { "code": "76856", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1180.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1029.5094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 598.75, "10th_percentile": 598.75, "90th_percentile": 598.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 823.61, "10th_percentile": 823.61, "90th_percentile": 823.61, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 692.66, "10th_percentile": 692.66, "90th_percentile": 720.37, "count": "26" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 643.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 285.72, "10th_percentile": 285.72, "90th_percentile": 298.46, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 823.6, "10th_percentile": 823.6, "90th_percentile": 823.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "395", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5983.0, "minimum": 4404.73, "maximum": 17472.0761, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5784.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11727.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5784.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5784.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12397.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5983.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4404.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5983.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12397.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5784.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5983.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5784.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7217.97 } ] } ] }, { "description": "HC DUPLEX LO EXTREM ART UNILAT/LTD", "code_information": [ { "code": "93926", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1249.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1089.1803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC STRAPPING KNEE", "code_information": [ { "code": "29530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.25, "discounted_cash": 131.0, "minimum": 88.875, "maximum": 296.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 296.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 296.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 296.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MANUAL THERAPY 1/> REGIONS EA 15 MIN", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 262.81, "discounted_cash": 26.0, "minimum": 25.8013, "maximum": 229.1703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.25, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES - G0463 - 76100003", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.19, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 212.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 212.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 212.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1845) KO DOUBLE UPRIGHT PRE CST", "code_information": [ { "code": "L1845", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1000.0, "minimum": 972.5483, "maximum": 1692.5022, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 972.55, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1000.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1000.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1090.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1000.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1000.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1692.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1000.77, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1215.64, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1000.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC", "code_information": [ { "code": "840", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25650.0, "minimum": 22072.12, "maximum": 78154.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24655.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58454.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24655.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24655.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 78154.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25650.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22072.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25650.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78154.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24655.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25650.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24655.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35977.52 } ] } ] }, { "description": "HC SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR", "code_information": [ { "code": "96370", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.88, "discounted_cash": 46.0, "minimum": 46.2, "maximum": 232.7194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FLUORESCENT ANTIBODY; TITER", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.69, "discounted_cash": 12.0, "minimum": 11.7102, "maximum": 235.1697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 162.8, "10th_percentile": 162.8, "90th_percentile": 162.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 188.13, "10th_percentile": 188.13, "90th_percentile": 188.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT I-P JT,TOE DISLOC W ANES", "code_information": [ { "code": "28665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 897.19, "discounted_cash": 275.0, "minimum": 269.157, "maximum": 897.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 897.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 897.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 897.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 466.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SPEECH/HEARING THERAPY, GROUP, 15 MIN", "code_information": [ { "code": "92508", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 343.13, "discounted_cash": 22.0, "minimum": 22.2639, "maximum": 299.2094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.83, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.26, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ceftaroline Fosamil for IV Soln 400 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00456040001", "type": "NDC" }, { "code": "J0712", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.1107, "maximum": 16.7591, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.11, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ DEV PLACE BREAST LOC 1ST LES W MAMMO GUID", "code_information": [ { "code": "19281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2744.69, "discounted_cash": 1629.0, "minimum": 823.407, "maximum": 2744.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2744.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2744.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2744.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2744.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THER APHERESIS,PLASMA PHERESIS", "code_information": [ { "code": "36514", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5290.31, "discounted_cash": 1536.0, "minimum": 1536.71, "maximum": 5290.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1536.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5290.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5290.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1536.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5290.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1536.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1536.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1536.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1675.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1536.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1536.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1536.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1536.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1536.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2598.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Insulin Regular (Human) in NaCl 0.9% IV Soln 100 Unit/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338012612", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC XRAY FEMUR 1 VW", "code_information": [ { "code": "73551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 437.81, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 85.42, "10th_percentile": 85.42, "90th_percentile": 85.42, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 305.42, "10th_percentile": 305.42, "90th_percentile": 305.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC GTT-ADDED SAMPLES", "code_information": [ { "code": "82952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.38, "discounted_cash": 3.0, "minimum": 3.8095, "maximum": 60.4994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 44.4, "10th_percentile": 37.3, "90th_percentile": 44.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 35.35, "10th_percentile": 35.35, "90th_percentile": 70.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 37.33, "10th_percentile": 37.33, "90th_percentile": 37.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.52, "10th_percentile": 17.52, "90th_percentile": 17.52, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 48.84, "10th_percentile": 20.5, "90th_percentile": 48.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAINAGE CATHETER EXCHANGE", "code_information": [ { "code": "49423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5528.44, "discounted_cash": 1893.0, "minimum": 1658.532, "maximum": 5528.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5528.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5528.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5528.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2063.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3202.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 - 80321 - 31080321", "code_information": [ { "code": "80321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 478.13, "minimum": 70.6798, "maximum": 416.9294, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 70.68, "10th_percentile": 70.68, "90th_percentile": 70.68, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L0630) LSO R POST PNL SJ-T9 PRE CST", "code_information": [ { "code": "L0630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 194.0, "minimum": 188.7819, "maximum": 328.5325, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 194.26, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 235.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 188.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 194.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 194.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 211.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 194.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 194.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 328.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hydromorphone HCl Preservative Free (PF) Inj 10 MG/ML - 00409263425", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00409263425", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.98, "10th_percentile": 11.99, "90th_percentile": 39.11, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 44.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF ACTH", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 574.38, "discounted_cash": 38.0, "minimum": 37.5309, "maximum": 500.8594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 367.6, "10th_percentile": 367.6, "90th_percentile": 367.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.91, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.53, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 292.7, "10th_percentile": 292.7, "90th_percentile": 292.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 315.03, "10th_percentile": 309.11, "90th_percentile": 315.03, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 172.63, "10th_percentile": 172.63, "90th_percentile": 172.63, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 404.36, "10th_percentile": 202.65, "90th_percentile": 404.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEPATITIS, DELTA AGENT", "code_information": [ { "code": "86692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.38, "discounted_cash": 17.0, "minimum": 16.6761, "maximum": 278.4994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MYELOGRAPHY LUMBAR INJ, THORACIC", "code_information": [ { "code": "62303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1341.56, "discounted_cash": 773.0, "minimum": 402.468, "maximum": 1341.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1341.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1341.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1341.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSIS", "code_information": [ { "code": "88363", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.88, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 149.4927, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOGRAM RENAL BILAT", "code_information": [ { "code": "75833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9452.81, "discounted_cash": 3115.0, "minimum": 696.1643, "maximum": 9452.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9452.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9452.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9452.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 696.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH CC", "code_information": [ { "code": "141", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17636.0, "minimum": 7204.98, "maximum": 39412.128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16965.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39412.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16965.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16965.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 7204.98 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17636.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14870.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17636.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7204.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16965.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17636.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16965.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24257.5 } ] } ] }, { "description": "HC XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG", "code_information": [ { "code": "94617", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 506.88, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 506.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 506.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 506.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC SLP STUDY, UNATND, RCRD HRT RATE/O2 SAT/RSP ANAL/SLP TM - 95800 - 74000031", "code_information": [ { "code": "95800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 641.88, "discounted_cash": 213.0, "minimum": 192.564, "maximum": 641.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 641.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 641.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 641.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MURAMIDASE", "code_information": [ { "code": "85549", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.25, "discounted_cash": 18.0, "minimum": 16.875, "maximum": 56.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.78, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TISSUE CULTURE, SKIN/SOLID TISS BIOPSY", "code_information": [ { "code": "88233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1158.13, "discounted_cash": 140.0, "minimum": 136.7614, "maximum": 1009.8894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.94, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 136.76, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 738.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 140.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 140.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 140.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 140.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 238.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEEDLE INSERTION W/O INJECTION 1 OR 2 MUSCLES", "code_information": [ { "code": "20560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.38, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 104.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 104.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0625) LO FLEX L1-BELOW L5 PRE OTS", "code_information": [ { "code": "L0625", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 42.0, "minimum": 41.593, "maximum": 72.3834, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.99, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.59, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 42.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 42.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC", "code_information": [ { "code": "326", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38979.0, "minimum": 35153.44, "maximum": 132871.6911, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37444.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 90121.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 37444.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 116217.02, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 46649.01, "10th_percentile": 46649.01, "90th_percentile": 46649.01, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37444.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 83751.63 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 38979.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35153.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38979.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 83751.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37444.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 38979.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37444.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55468.27 } ] } ] }, { "description": "HC CLSD TREAT TALOTARSAL DISLOC W ANES", "code_information": [ { "code": "28570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1205.0, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 1164.7437, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Magnesium Sulfate Inj 50%", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "31722039431", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0535, "maximum": 1.0535, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 72.46, "10th_percentile": 72.46, "90th_percentile": 144.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 80.49, "10th_percentile": 80.49, "90th_percentile": 80.49, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF BENZODIAZEPINES - 80346 - 30100410", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 352.81, "minimum": 84.5324, "maximum": 307.6503, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.53 } ] } ] }, { "description": "HC INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG", "code_information": [ { "code": "33285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42868.8, "discounted_cash": 8165.0, "minimum": 8165.34, "maximum": 39076.8676, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32168.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39076.87, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31262.64, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CELL COUNT,MISC BODY FLUIDS", "code_information": [ { "code": "89050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.63, "discounted_cash": 4.0, "minimum": 4.5869, "maximum": 144.4294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.59, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 84.4, "10th_percentile": 84.4, "90th_percentile": 84.4, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 171.4, "10th_percentile": 171.4, "90th_percentile": 171.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 42.2, "10th_percentile": 42.2, "90th_percentile": 42.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6259) TRANSPARENT FILM > 48 SQ IN", "code_information": [ { "code": "A6259", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 15.0, "minimum": 15.1504, "maximum": 26.3658, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30486.0, "minimum": 26914.98, "maximum": 84080.5334, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29295.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 69942.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 29295.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 29295.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 83710.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 30486.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26914.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30486.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 83710.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29295.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 30486.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29295.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43048.69 } ] } ] }, { "description": "HC ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED - G0480 - 31080338", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 438.13, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 438.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ NERV BLCK, FEMORAL, SINGLE", "code_information": [ { "code": "64447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1903.13, "discounted_cash": 696.0, "minimum": 570.939, "maximum": 1903.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1903.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1903.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1903.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOFIX E-PHORESIS, SERUM", "code_information": [ { "code": "86334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.31, "discounted_cash": 22.0, "minimum": 21.71, "maximum": 305.4703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 138.1, "10th_percentile": 112.06, "90th_percentile": 164.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.14, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 138.71, "10th_percentile": 138.71, "90th_percentile": 138.71, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 114.32, "10th_percentile": 112.17, "90th_percentile": 146.48, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 146.74, "10th_percentile": 22.34, "90th_percentile": 189.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Chlorpromazine HCl Tab 25 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50268016311", "type": "NDC" }, { "code": "Q0161", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10023.0, "minimum": 8050.2, "maximum": 30008.8336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9660.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21326.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9660.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9660.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17821.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10023.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8050.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10023.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17821.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9660.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10023.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9660.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13125.81 } ] } ] }, { "description": "Zoledronic Acid IV Soln 4 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "25021082682", "type": "NDC" }, { "code": "J3489", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.501, "maximum": 17.501, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.5 } ] } ] }, { "description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC", "code_information": [ { "code": "556", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7365.0, "minimum": 5651.27, "maximum": 17632.3994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15008.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13870.28 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7365.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5651.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7365.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13870.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7365.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9237.67 } ] } ] }, { "description": "HC X-RAYS, BONE SURVEY COMPLETE", "code_information": [ { "code": "77075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 686.9703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 646.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4002) CAST SUP BODY CAST FIBERGLAS", "code_information": [ { "code": "Q4002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 235.0, "minimum": 228.995, "maximum": 398.5144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 235.64, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 286.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 228.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.51, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THORACENTESIS NDL/CATH PLEURA ASP WO IMAG", "code_information": [ { "code": "32554", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2691.25, "discounted_cash": 618.0, "minimum": 618.95, "maximum": 2691.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2438.42, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2691.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2369.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TESTES PROCEDURES WITH CCMCC", "code_information": [ { "code": "711", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16896.0, "minimum": 13203.13, "maximum": 45065.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16255.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37653.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16255.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16255.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 45065.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16896.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13203.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16896.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45065.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16255.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16896.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16255.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23175.36 } ] } ] }, { "description": "HC PERQ PLCMT BILE DUCT STENT,NEW ACCESS W SEP CATH", "code_information": [ { "code": "47540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19083.1, "discounted_cash": 5965.0, "minimum": 5724.93, "maximum": 19083.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10088.24, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19083.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19083.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19083.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6502.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4345) MATRIX HD ALLOGRFT PER SQ CM", "code_information": [ { "code": "Q4345", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HLA TYPING DR/DQ", "code_information": [ { "code": "86817", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 859.06, "discounted_cash": 106.0, "minimum": 103.1469, "maximum": 749.1003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.93, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 556.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 106.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 106.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 106.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 179.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IA INFECTIOUS AGT ANTIBODY SARS-COV-2 COVID-19", "code_information": [ { "code": "86328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.19, "discounted_cash": 45.0, "minimum": 44.0031, "maximum": 263.5097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPEAT CONTROL OF NOSEBLEED", "code_information": [ { "code": "30906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 452.19, "discounted_cash": 233.0, "minimum": 135.657, "maximum": 452.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 452.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 452.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 452.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX UP EXTREM ART UNILAT/LTD", "code_information": [ { "code": "93931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1318.13, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1149.4094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTHER, IV INFUSION, 1 HR", "code_information": [ { "code": "96413", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1449.06, "discounted_cash": 325.0, "minimum": 325.91, "maximum": 1449.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 741.89, "10th_percentile": 741.89, "90th_percentile": 741.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1283.96, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1449.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1247.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 11740.27, "10th_percentile": 1206.27, "90th_percentile": 22680.11, "count": "15" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 846.33, "10th_percentile": 846.33, "90th_percentile": 846.33, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 910.01, "10th_percentile": 234.87, "90th_percentile": 910.01, "count": "27" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 971.52, "10th_percentile": 846.33, "90th_percentile": 1010.87, "count": "43" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 551.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT GASTROSTOMY TUBE PERCUTANEOUS", "code_information": [ { "code": "49440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 738.44, "discounted_cash": 1893.0, "minimum": 221.532, "maximum": 738.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 738.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC XRAY HIP W PELVIS, UNILAT 2-3 VW", "code_information": [ { "code": "73502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 431.25, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 260.4, "10th_percentile": 260.4, "90th_percentile": 260.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 218.73, "10th_percentile": 34.35, "90th_percentile": 218.73, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 253.04, "10th_percentile": 253.04, "90th_percentile": 263.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 324.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 146.17, "10th_percentile": 146.17, "90th_percentile": 146.17, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 286.44, "10th_percentile": 249.53, "90th_percentile": 300.84, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN CERV SP COMBO", "code_information": [ { "code": "72127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1910.0, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1665.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1257.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4352) COUDE TIP URINARY CATHETER", "code_information": [ { "code": "A4352", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 8.892, "maximum": 15.4745, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Daptomycin For IV Soln 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505622904", "type": "NDC" }, { "code": "J0878", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 253.9, "10th_percentile": 253.9, "90th_percentile": 253.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION", "code_information": [ { "code": "76983", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 474.06, "minimum": 142.218, "maximum": 413.3803, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 324.67 } ] } ] }, { "description": "HC CLSD TREAT DISTL RAD/ULNA FX WO MANIP", "code_information": [ { "code": "25600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 480.0, "discounted_cash": 243.0, "minimum": 144.0, "maximum": 480.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN DEBRIDEMENT WITHOUT CCMCC", "code_information": [ { "code": "572", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9766.0, "minimum": 7906.93, "maximum": 40825.3134, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9413.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20713.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9413.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9413.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33608.98 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9766.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7906.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9766.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33609.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9413.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9766.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9413.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12748.78 } ] } ] }, { "description": "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES", "code_information": [ { "code": "004", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 106393.0, "minimum": 97798.39, "maximum": 397986.0814, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 102132.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 250292.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 102132.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 102132.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 359771.95 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 106393.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97798.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 106393.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 359772.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 102132.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 106393.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 102132.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 154050.84 } ] } ] }, { "description": "HEADACHES WITHOUT MCC", "code_information": [ { "code": "103", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7408.0, "minimum": 5884.51, "maximum": 29298.0722, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15111.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17221.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7408.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5884.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7408.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17221.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7408.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7151.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9301.06 } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10906.0, "minimum": 9039.26, "maximum": 28034.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23423.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28034.76 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10906.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9039.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10906.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28034.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10906.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14417.03 } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9403.0, "minimum": 7420.36, "maximum": 30507.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9065.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19851.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9065.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9065.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30507.21 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9403.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7420.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9403.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30507.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9065.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9403.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9065.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12218.28 } ] } ] }, { "description": "HC CLSD TREAT PROX/SHAFT FIB FX W MANIP", "code_information": [ { "code": "27781", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.75, "discounted_cash": 1586.0, "minimum": 263.625, "maximum": 878.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH MCC", "code_information": [ { "code": "597", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13727.0, "minimum": 12158.7, "maximum": 30124.2303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13214.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30124.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13214.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13214.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26343.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13727.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12158.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26343.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13214.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13727.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13214.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18540.95 } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC", "code_information": [ { "code": "940", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18821.0, "minimum": 14613.7, "maximum": 43314.9781, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 42227.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34168.16 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18821.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14613.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18821.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34168.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18821.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25990.25 } ] } ] }, { "description": "HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGT", "code_information": [ { "code": "87633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 495.63, "discounted_cash": 416.0, "minimum": 148.689, "maximum": 495.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 299.2, "10th_percentile": 251.33, "90th_percentile": 299.2, "count": "25" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 495.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 405.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 266.73, "10th_percentile": 256.41, "90th_percentile": 266.73, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 374.0, "10th_percentile": 299.2, "90th_percentile": 396.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 454.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 374.0, "10th_percentile": 374.0, "90th_percentile": 374.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 495.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ERGONOVINE PROVOCATION TST", "code_information": [ { "code": "93024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 804.06, "discounted_cash": 440.0, "minimum": 241.218, "maximum": 804.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 804.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 804.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 804.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 745.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF GENTAMICIN", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.81, "discounted_cash": 16.0, "minimum": 15.9181, "maximum": 259.6903, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.7, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.9, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" } ] } ] }, { "description": "HC EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST", "code_information": [ { "code": "25248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6873.75, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 6873.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6250.61, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6873.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6074.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY WRIST 3+ VW", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 487.81, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 425.3703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 294.6, "10th_percentile": 130.12, "90th_percentile": 294.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 233.47, "10th_percentile": 233.47, "90th_percentile": 247.42, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 297.64, "10th_percentile": 286.28, "90th_percentile": 297.64, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 130.3, "10th_percentile": 130.3, "90th_percentile": 130.3, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 324.06, "10th_percentile": 299.17, "90th_percentile": 340.3, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3913) HFO W/O JOINTS CF", "code_information": [ { "code": "L3913", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 295.0, "minimum": 287.3224, "maximum": 500.0202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 359.14, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 287.32, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 322.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 500.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ECHO HEART XTHORACIC,LIMITED - 93308 - 48300002", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1870.94, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1631.4597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1005.82, "10th_percentile": 1005.82, "90th_percentile": 1005.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 1142.02, "10th_percentile": 1142.02, "90th_percentile": 1142.02, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1163.57, "10th_percentile": 1141.57, "90th_percentile": 1163.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1147.41, "10th_percentile": 1147.41, "90th_percentile": 1147.41, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 321.58, "10th_percentile": 321.58, "90th_percentile": 321.58, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1305.17, "10th_percentile": 233.95, "90th_percentile": 1317.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PARTICLE AGGLUT ANTBDY TITR", "code_information": [ { "code": "86406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.13, "discounted_cash": 10.0, "minimum": 10.34, "maximum": 85.5694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.99, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL", "code_information": [ { "code": "77046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1235.31, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1235.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1235.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLASTOMYCES, ANTIBODY", "code_information": [ { "code": "86612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.25, "discounted_cash": 12.0, "minimum": 12.5362, "maximum": 201.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [ { "code": "696", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6288.0, "minimum": 4788.18, "maximum": 21061.4879, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6076.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12450.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6076.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6076.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9274.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6288.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4788.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6288.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9274.13 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6076.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6288.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6076.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7662.84 } ] } ] }, { "description": "HC (SUP SHELL E0990) WHEELCHAIR ELEVATING LEG RES", "code_information": [ { "code": "E0990", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 79.0, "minimum": 77.1123, "maximum": 134.1967, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.39, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.11, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 134.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF THYROXINE BNDNG GLOBULIN", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.63, "discounted_cash": 14.0, "minimum": 14.3632, "maximum": 183.6694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.95, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [ { "code": "274", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26082.0, "minimum": 21601.47, "maximum": 83304.9996, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25070.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 59480.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25070.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25070.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 72379.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 26082.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21601.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26082.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 72379.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25070.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 26082.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25070.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36609.23 } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [ { "code": "194", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7177.0, "minimum": 5675.49, "maximum": 19598.519, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6929.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14562.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6929.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 17141.96, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12109.13, "10th_percentile": 12109.13, "90th_percentile": 41266.93, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6929.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13685.18 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 19553.57, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11314.89, "10th_percentile": 11314.89, "90th_percentile": 11314.89, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7177.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5675.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7177.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13685.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 19598.52, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22890.16, "10th_percentile": 22890.16, "90th_percentile": 22890.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6929.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7177.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6929.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8962.96 } ] } ] }, { "description": "HC CHEMILUMINESCENT ASSAY", "code_information": [ { "code": "82397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.19, "discounted_cash": 14.0, "minimum": 13.7218, "maximum": 132.7097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "623", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14691.0, "minimum": 13239.12, "maximum": 45794.0828, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32415.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27949.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14691.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13239.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14691.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27949.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14691.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14139.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19951.18 } ] } ] }, { "description": "HC (SUP SHELL Q4158) KERECIS OMEGA3, PER SQ CM", "code_information": [ { "code": "Q4158", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ BREAST LOC DEV PLACE US GUIDE 1ST LESION", "code_information": [ { "code": "19285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1223.13, "discounted_cash": 698.0, "minimum": 366.939, "maximum": 1223.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 782.8, "10th_percentile": 782.8, "90th_percentile": 782.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1223.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1223.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1223.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RMVL FB XTRNL AUDITORY CANAL ANES", "code_information": [ { "code": "69205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11648.1, "discounted_cash": 1629.0, "minimum": 1629.64, "maximum": 10157.1432, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6420.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7798.97, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6239.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "code_information": [ { "code": "193", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11044.0, "minimum": 9120.24, "maximum": 25296.772, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 22772.9, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16288.13, "10th_percentile": 15288.83, "90th_percentile": 19550.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23751.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 22125.97, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22799.08, "10th_percentile": 22799.08, "90th_percentile": 22799.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 22195.6, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15653.33, "10th_percentile": 15653.33, "90th_percentile": 15653.33, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19323.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11044.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9120.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11044.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19323.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 25296.77, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22519.51, "10th_percentile": 22519.51, "90th_percentile": 22519.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11044.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14618.34 } ] } ] }, { "description": "HC ASSAY OF SERUM ALBUMIN", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.31, "discounted_cash": 4.0, "minimum": 4.8104, "maximum": 39.5103, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 24.36, "10th_percentile": 24.36, "90th_percentile": 29.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 23.09, "10th_percentile": 23.09, "90th_percentile": 23.09, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 24.85, "10th_percentile": 24.39, "90th_percentile": 24.85, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 22.13, "10th_percentile": 22.13, "90th_percentile": 29.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 31.9, "10th_percentile": 25.89, "90th_percentile": 31.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ED LEVEL 4", "code_information": [ { "code": "99284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1961.88, "discounted_cash": 411.0, "minimum": 411.71, "maximum": 1961.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 917.11, "10th_percentile": 917.11, "90th_percentile": 1091.8, "count": "52" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1621.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1961.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1576.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 1197.53, "10th_percentile": 1197.53, "90th_percentile": 1197.53, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1197.06, "10th_percentile": 1060.96, "90th_percentile": 1197.06, "count": "119" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1442.57, "10th_percentile": 1144.82, "90th_percentile": 1898.92, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1080.88, "10th_percentile": 917.11, "90th_percentile": 1232.06, "count": "34" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 448.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1200.98, "10th_percentile": 1200.98, "90th_percentile": 1368.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "407", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17928.0, "minimum": 14782.58, "maximum": 51289.7048, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17246.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 40107.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17246.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 45002.01, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 23208.23, "10th_percentile": 23208.23, "90th_percentile": 51977.86, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17246.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46592.76 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17928.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14782.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17928.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46592.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17246.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17928.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17246.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24685.68 } ] } ] }, { "description": "Fomepizole Inj 1 GM/ML (For IV Infusion)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "67457021102", "type": "NDC" }, { "code": "J1451", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.539, "maximum": 27.7135, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT PULSE GEN,SNGL/DUAL", "code_information": [ { "code": "33240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118780.0, "discounted_cash": 21947.0, "minimum": 21947.8, "maximum": 105035.5865, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86465.55, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105035.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84031.54, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23923.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37118.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3995) SOCK FRACTURE OR EQUAL EACH", "code_information": [ { "code": "L3995", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 49.0, "minimum": 47.6376, "maximum": 82.9026, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.54, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 47.64, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED ULTRASOUND PROCEDURE", "code_information": [ { "code": "76999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.63, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 576.0694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "393", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13211.0, "minimum": 11461.72, "maximum": 43364.6071, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12719.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28899.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12719.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12719.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25940.29 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11461.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25940.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12719.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13211.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12719.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17786.9 } ] } ] }, { "description": "HC CULTURE TYPING, SEROLOGIC", "code_information": [ { "code": "87147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.75, "discounted_cash": 5.0, "minimum": 5.0339, "maximum": 33.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 19.6, "10th_percentile": 19.6, "90th_percentile": 43.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 15.61, "10th_percentile": 15.61, "90th_percentile": 15.61, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 17.49, "10th_percentile": 16.8, "90th_percentile": 38.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.15, "10th_percentile": 23.15, "90th_percentile": 46.31, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 25.74, "10th_percentile": 25.74, "90th_percentile": 25.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BCR/ABL1 GENE MAJOR BP", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1550.31, "discounted_cash": 163.0, "minimum": 159.3363, "maximum": 1351.8703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 199.16, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 159.34, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 860.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 277.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC T CELLS, TOTAL COUNT", "code_information": [ { "code": "86359", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.81, "discounted_cash": 37.0, "minimum": 36.666, "maximum": 132.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 92.65, "10th_percentile": 92.65, "90th_percentile": 92.65, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC", "code_information": [ { "code": "626", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12451.0, "minimum": 10446.36, "maximum": 30933.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11990.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27093.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11990.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11990.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30933.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12451.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10446.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12451.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30933.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11990.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12451.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11990.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16675.85 } ] } ] }, { "description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [ { "code": "948", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7136.0, "minimum": 5499.0, "maximum": 30855.5224, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 27777.05, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13289.82, "10th_percentile": 13289.82, "90th_percentile": 13289.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6889.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14464.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6889.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 27072.89, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13127.79, "10th_percentile": 13127.79, "90th_percentile": 19299.66, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6889.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16444.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7136.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5499.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7136.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16444.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6889.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7136.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6889.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8902.9 } ] } ] }, { "description": "HC US GUIDE, VASCULAR ACCESS", "code_information": [ { "code": "76937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 711.56, "minimum": 213.468, "maximum": 620.4803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 344.06, "10th_percentile": 344.06, "90th_percentile": 409.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 413.96, "10th_percentile": 398.03, "90th_percentile": 413.96, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.42 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 98.61, "10th_percentile": 98.61, "90th_percentile": 98.61, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 450.56, "10th_percentile": 416.07, "90th_percentile": 496.39, "count": "1 through 10" } ] } ] }, { "description": "Estradiol Valerate IM in Oil 10 MG/ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "42023011001", "type": "NDC" }, { "code": "J1380", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 15.695, "maximum": 15.695, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.7 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CCMCC", "code_information": [ { "code": "717", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15426.0, "minimum": 12842.53, "maximum": 134683.5043, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34161.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40886.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12842.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40886.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21025.54 } ] } ] }, { "description": "HC CSF VENTRICULOGRAPHY", "code_information": [ { "code": "78635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.5, "discounted_cash": 535.0, "minimum": 371.25, "maximum": 1237.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1237.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [ { "code": "958", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33096.0, "minimum": 28445.28, "maximum": 85468.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 68499.53, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 49785.71, "10th_percentile": 49785.71, "90th_percentile": 49785.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31799.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 76144.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31799.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31799.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 85468.12 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33096.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28445.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33096.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 85468.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31799.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 33096.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31799.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46865.65 } ] } ] }, { "description": "HC (SUP SHELL Q4125) ARTHROFLEX", "code_information": [ { "code": "Q4125", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC", "code_information": [ { "code": "629", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17618.0, "minimum": 15566.76, "maximum": 48495.189, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16948.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39370.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16948.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 42416.61, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 27072.71, "10th_percentile": 27072.71, "90th_percentile": 27072.71, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16948.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37675.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17618.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15566.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17618.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37675.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16948.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17618.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16948.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24231.92 } ] } ] }, { "description": "HC AMINO ACIDS, 6+ QUANT", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1735.0, "discounted_cash": 16.0, "minimum": 16.3943, "maximum": 1512.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IADNA DNA/RNA RSV AMPLIFIED PROBE TECHNIQUE", "code_information": [ { "code": "87634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.69, "discounted_cash": 70.0, "minimum": 68.2204, "maximum": 264.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 159.8, "10th_percentile": 134.23, "90th_percentile": 159.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.27, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 136.95, "10th_percentile": 136.95, "90th_percentile": 136.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 264.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 159.8, "10th_percentile": 159.8, "90th_percentile": 199.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 175.78, "10th_percentile": 175.78, "90th_percentile": 199.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OBSTETRICAL CARE,VAG DELIV ONLY", "code_information": [ { "code": "59409", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9491.56, "discounted_cash": 3194.0, "minimum": 2847.468, "maximum": 9491.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9491.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9491.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9491.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3481.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3194.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5401.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4259) LANCETS PER BOX", "code_information": [ { "code": "A4259", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.38, "maximum": 2.4015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.38, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FIBRINOGEN, ACTIVITY", "code_information": [ { "code": "85384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.69, "discounted_cash": 9.0, "minimum": 9.4459, "maximum": 143.6097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 43.45, "10th_percentile": 43.45, "90th_percentile": 43.45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 51.0, "10th_percentile": 51.0, "90th_percentile": 51.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE", "code_information": [ { "code": "43771", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22340.3, "minimum": 6702.09, "maximum": 22340.3, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22340.3 } ] } ] }, { "description": "HC (SUP SHELL Q4162) WNDEX FLW, BIOSKN FLW, 0.5CC", "code_information": [ { "code": "Q4162", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4020.5, "maximum": 4020.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4020.5 } ] } ] }, { "description": "HC TRANSCATHETER RX EMBOLIZATN", "code_information": [ { "code": "75894", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5074.06, "minimum": 1522.218, "maximum": 5074.06, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5074.06 } ] } ] }, { "description": "HC X-RAY MASTOIDS <3 VW", "code_information": [ { "code": "70120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 606.56, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 528.9203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX ABD/PEL VASC STUDY,LIMITD", "code_information": [ { "code": "93976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2032.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1772.6103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 505.15, "10th_percentile": 505.15, "90th_percentile": 505.15, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM BONE IMAGING, WHOLE BODY", "code_information": [ { "code": "78306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1461.88, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1461.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1461.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1461.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1461.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1461.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITH MCC", "code_information": [ { "code": "183", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12683.0, "minimum": 10986.23, "maximum": 32777.3801, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 29507.16, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 65331.46, "10th_percentile": 65331.46, "90th_percentile": 65331.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12212.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27645.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12212.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12212.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17899.46 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12683.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10986.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12683.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17899.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12212.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12683.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12212.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17015.06 } ] } ] }, { "description": "HC HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE", "code_information": [ { "code": "28160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14699.4, "discounted_cash": 3228.0, "minimum": 3228.48, "maximum": 14699.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12718.92, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14699.4, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12360.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF LDH ISOENZYMES", "code_information": [ { "code": "83625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.25, "discounted_cash": 12.0, "minimum": 12.4293, "maximum": 201.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.54, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6407) PACKING STRIPS, NON-IMPREG - A6407 - 27200155", "code_information": [ { "code": "A6407", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.585, "maximum": 4.4986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM O.R. PROCEDURES", "code_information": [ { "code": "264", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26454.0, "minimum": 24190.74, "maximum": 60364.1075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25426.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 60364.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25426.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25426.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 57131.37 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 26454.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24190.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26454.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57131.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25426.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 26454.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25426.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37153.08 } ] } ] }, { "description": "HC INSITU HYBRIDIZE, PER SPCMN, INIT SING PROB STAIN", "code_information": [ { "code": "88365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "discounted_cash": 168.0, "minimum": 120.0, "maximum": 400.0, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.29, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 400.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4399) OSTOMY IRRIG CONE/CATH W BRS", "code_information": [ { "code": "A4399", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 17.0, "minimum": 16.9871, "maximum": 29.5622, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND SMP FACE 20.1-30 CM", "code_information": [ { "code": "12017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1688.13, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 1688.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1688.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC TPVT ST ATHRC UNI SF LES 1ST VSL", "code_information": [ { "code": "37292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC F2 GENE ANALYSIS 20210G >A VARIANT", "code_information": [ { "code": "81240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.06, "discounted_cash": 65.0, "minimum": 55.218, "maximum": 184.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.79, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.84, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLACE NEPHROURETERAL CATH, PERQ W IMG", "code_information": [ { "code": "50433", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8862.19, "discounted_cash": 3478.0, "minimum": 2658.657, "maximum": 8862.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8862.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8862.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8862.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3791.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5882.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM", "code_information": [ { "code": "96401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 523.44, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 456.4397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 267.96, "10th_percentile": 267.96, "90th_percentile": 638.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 279.87, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.99, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MAMMARY DUCTOGRAM, MULTIPLE", "code_information": [ { "code": "77054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 722.19, "discounted_cash": 235.0, "minimum": 216.657, "maximum": 722.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 722.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 722.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 722.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 424.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CALCIUM IN URINE", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.94, "discounted_cash": 6.0, "minimum": 5.86, "maximum": 96.7397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.32, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 56.53, "10th_percentile": 56.53, "90th_percentile": 56.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 77.39, "10th_percentile": 77.39, "90th_percentile": 77.39, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7671.0, "minimum": 6096.31, "maximum": 19560.0644, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 17608.54, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6787.99, "10th_percentile": 6787.99, "90th_percentile": 6787.99, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7403.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15737.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7403.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 17108.33, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7039.47, "10th_percentile": 7039.47, "90th_percentile": 12039.04, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7403.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11571.23 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7671.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6096.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7671.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11571.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7403.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7671.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7403.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9685.87 } ] } ] }, { "description": "HC CLSD TREAT ULNA STYLOID FX", "code_information": [ { "code": "25650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 759.06, "discounted_cash": 243.0, "minimum": 227.718, "maximum": 759.06, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 759.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 759.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 759.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "Lidocaine HCl Local Preservative Free (PF) Inj 1%", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00143959501", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.13, "90th_percentile": 25.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.7, "10th_percentile": 15.7, "90th_percentile": 15.7, "count": "1 through 10" } ] } ] }, { "description": "HC ANTISTREPTOLYSIN O TITER", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.44, "discounted_cash": 7.0, "minimum": 7.0941, "maximum": 107.6397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.09, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR MALE PELVIC PROCEDURES WITH CCMCC", "code_information": [ { "code": "707", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16261.0, "minimum": 13431.53, "maximum": 55802.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36145.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 55802.6 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16261.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13431.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16261.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55802.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16261.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22246.7 } ] } ] }, { "description": "HC PHLEBOTOMY THERAPUTIC", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 504.38, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 504.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 258.22, "10th_percentile": 258.22, "90th_percentile": 258.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 504.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 504.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 307.87, "10th_percentile": 307.87, "90th_percentile": 307.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 309.32, "10th_percentile": 294.57, "90th_percentile": 309.32, "count": "19" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "909", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11031.0, "minimum": 8778.32, "maximum": 28236.9122, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23720.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23641.23 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11031.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8778.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11031.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23641.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11031.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14599.43 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15971.0, "minimum": 13318.72, "maximum": 71533.9372, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15367.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35456.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15367.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 62764.47, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 70062.46, "10th_percentile": 70062.46, "90th_percentile": 70062.46, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15367.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47561.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15971.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13318.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15971.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47561.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15367.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15971.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15367.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21822.96 } ] } ] }, { "description": "HC NJX AA&/STRD TFRML EPI CERVICAL/THORACIC 1 LEVEL", "code_information": [ { "code": "64479", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3680.94, "discounted_cash": 872.0, "minimum": 872.7, "maximum": 3680.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3438.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3680.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3341.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "630", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12148.0, "minimum": 9698.86, "maximum": 31074.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11699.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26372.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11699.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11699.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31074.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12148.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9698.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12148.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31074.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11699.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12148.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11699.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16232.09 } ] } ] }, { "description": "HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC", "code_information": [ { "code": "85007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.31, "discounted_cash": 3.0, "minimum": 3.6928, "maximum": 39.5103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 30.14, "10th_percentile": 30.14, "90th_percentile": 31.61, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ORGANIC ACIDS TOTAL QUANT", "code_information": [ { "code": "83918", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 556.56, "discounted_cash": 23.0, "minimum": 22.9345, "maximum": 485.3203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEPHELOMETRY, NOT SPECIFIED", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.69, "discounted_cash": 13.0, "minimum": 13.2165, "maximum": 147.9697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 239.0, "10th_percentile": 200.76, "90th_percentile": 239.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 190.3, "10th_percentile": 190.3, "90th_percentile": 190.3, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 204.82, "10th_percentile": 200.97, "90th_percentile": 204.82, "count": "15" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 260.51, "10th_percentile": 27.2, "90th_percentile": 262.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC", "code_information": [ { "code": "739", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28296.0, "minimum": 27194.3, "maximum": 64740.6228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 64740.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 55502.55 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28296.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27553.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28296.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55502.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28296.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27194.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39846.76 } ] } ] }, { "description": "HC REPR WND SMP BODY/SCALP/EXTR 20.1-30 CM", "code_information": [ { "code": "12006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 522.5, "discounted_cash": 401.0, "minimum": 156.75, "maximum": 522.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 522.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 522.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 522.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 522.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4104) INTEGRA BMWD PER SQ CM", "code_information": [ { "code": "Q4104", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 107.0485, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8118.0, "minimum": 6775.98, "maximum": 20106.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7832.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16799.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7832.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7832.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20106.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6775.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20106.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7832.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7832.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10339.83 } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9186.0, "minimum": 7542.17, "maximum": 30318.6537, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 27293.74, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 21387.88, "10th_percentile": 21387.88, "90th_percentile": 21387.88, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8857.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19336.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8857.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 26518.39, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 29739.48, "10th_percentile": 29739.48, "90th_percentile": 29739.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 26601.84, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 21872.14, "10th_percentile": 21872.14, "90th_percentile": 21872.14, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8857.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23156.1 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9186.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7542.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9186.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23156.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 30318.65, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 17374.98, "10th_percentile": 17374.98, "90th_percentile": 17374.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8857.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9186.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8857.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11901.31 } ] } ] }, { "description": "Cefazolin Sodium For Inj 10 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567070810", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7845, "maximum": 1.7845, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.87, "10th_percentile": 11.99, "90th_percentile": 26.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.78 } ] } ] }, { "description": "HC DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL", "code_information": [ { "code": "93980", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1222.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1066.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ESOPHAGRAM", "code_information": [ { "code": "74220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.69, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1028.6897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 719.8, "10th_percentile": 719.8, "90th_percentile": 719.8, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 608.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO PULMON UNILAT SELECT", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1672.81, "discounted_cash": 3115.0, "minimum": 501.843, "maximum": 1672.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 620.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1672.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED PROCEDURE MALE GENITAL SYSTEM", "code_information": [ { "code": "55899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1444.38, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1259.4994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF 5-HIAA", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.06, "discounted_cash": 12.0, "minimum": 12.5362, "maximum": 160.5003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 129.58, "10th_percentile": 129.58, "90th_percentile": 129.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3984) UPPER EXT FX ORTHOSIS WRIST", "code_information": [ { "code": "L3984", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 485.0, "minimum": 472.2754, "maximum": 821.8894, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 485.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 485.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 485.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 529.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 485.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 485.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 485.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 485.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 485.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 821.89, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 485.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 485.98, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 590.32, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 485.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 472.28, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" } ] } ] }, { "description": "Mycophenolate Mofetil Tab 500 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904707861", "type": "NDC" }, { "code": "J7517", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "759", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6094.0, "minimum": 4429.65, "maximum": 18609.2648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5890.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11991.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5890.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5890.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11520.57 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6094.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4429.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6094.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11520.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5890.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6094.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5890.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7380.35 } ] } ] }, { "description": "Famotidine Inj 20 MG/2ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "67457043300", "type": "NDC" }, { "code": "J1308", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "1 through 10" } ] } ] }, { "description": "HC BX LOW LEG SOFT TISSUE,DEEP", "code_information": [ { "code": "27614", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7525.94, "discounted_cash": 2866.0, "minimum": 2257.782, "maximum": 7525.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7525.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7525.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7525.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4847.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PNEUMOTHORAX WITHOUT CCMCC", "code_information": [ { "code": "201", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6486.0, "minimum": 4686.43, "maximum": 14350.6771, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 12918.9, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15383.4, "10th_percentile": 15383.4, "90th_percentile": 15383.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6266.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12921.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6266.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6266.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8901.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6486.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4686.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6486.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8901.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6266.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6486.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6266.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7953.11 } ] } ] }, { "description": "Procainamide HCl Inj 100 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "76329339905", "type": "NDC" }, { "code": "J2690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 214.0, "minimum": 214.811, "maximum": 846.2694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 846.27, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 357.96, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 286.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 611.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 214.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 214.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 234.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 214.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 214.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 363.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16831.0, "minimum": 12434.17, "maximum": 37500.339, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16193.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37500.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16193.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16193.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27596.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16831.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12434.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16831.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27596.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16193.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16831.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16193.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23080.82 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6143.0, "minimum": 4439.5308, "maximum": 12106.7928, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5937.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12106.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5937.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5937.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10984.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6143.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4821.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6143.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10984.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 6598.38, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4912.05, "10th_percentile": 4912.05, "90th_percentile": 4912.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5937.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6143.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5937.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7451.53 } ] } ] }, { "description": "HC DEBRIDE W FB REMOVE, FX/DISLOC", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2327.5, "discounted_cash": 698.0, "minimum": 698.25, "maximum": 2327.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12559.0, "minimum": 10473.36, "maximum": 56426.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27350.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56426.07 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12559.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10473.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12559.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56426.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12559.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12093.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16833.77 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10901.0, "minimum": 9235.82, "maximum": 52170.6513, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10503.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23411.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10503.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 45774.96, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 75374.22, "10th_percentile": 75374.22, "90th_percentile": 75374.22, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10503.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29363.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10901.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9235.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10901.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29363.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10503.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10901.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10503.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14409.25 } ] } ] }, { "description": "HC ASSAY OF CK (CPK)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.13, "discounted_cash": 6.0, "minimum": 6.3264, "maximum": 146.6094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 107.6, "10th_percentile": 90.38, "90th_percentile": 107.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.91, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 85.68, "10th_percentile": 85.68, "90th_percentile": 85.68, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 92.21, "10th_percentile": 90.48, "90th_percentile": 92.21, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 29.1, "10th_percentile": 29.1, "90th_percentile": 29.1, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 117.28, "10th_percentile": 117.28, "90th_percentile": 117.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VIRAL MENINGITIS WITH CCMCC", "code_information": [ { "code": "075", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15631.0, "minimum": 11504.63, "maximum": 34648.9182, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11504.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15631.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19840.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15041.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15631.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15041.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21325.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15041.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34648.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15041.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15041.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19840.02 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15631.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4199) CYGNUS MATRIX, PER SQ CM", "code_information": [ { "code": "Q4199", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 714.703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 714.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EEG,W/AWAKE & DROWSY RECORD", "code_information": [ { "code": "95816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 937.81, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 937.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 937.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 301.39, "10th_percentile": 301.39, "90th_percentile": 301.39, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TC-99M, PER STUDY DOSE", "code_information": [ { "code": "A9500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 407.19, "minimum": 122.157, "maximum": 355.0697, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.11 } ] } ] }, { "description": "HC REVSC EVASC TPVT ANGIOP UNI SF LES 1ST VSL", "code_information": [ { "code": "37280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55875.3, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 54512.3773, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44874.72, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54512.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RMV AORTIC BALLOON DEVICE", "code_information": [ { "code": "33968", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4674.69, "minimum": 1402.407, "maximum": 4674.69, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 4674.69 } ] } ] }, { "description": "PENIS PROCEDURES WITH CCMCC", "code_information": [ { "code": "709", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18746.0, "minimum": 15552.92, "maximum": 50327.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18030.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 42050.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18030.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18030.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 50327.74 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18746.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15552.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18746.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50327.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18030.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18746.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18030.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25881.26 } ] } ] }, { "description": "HC EGFR GENE COM VARIANTS", "code_information": [ { "code": "81235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2628.13, "discounted_cash": 324.0, "minimum": 315.4268, "maximum": 2291.7294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 394.27, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 315.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1703.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 548.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY VIT D, 25-HYDROXY W FRACTIONS", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.31, "discounted_cash": 29.0, "minimum": 28.7653, "maximum": 140.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 89.8, "10th_percentile": 75.43, "90th_percentile": 89.8, "count": "65" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.96, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.77, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 71.5, "10th_percentile": 71.5, "90th_percentile": 71.5, "count": "34" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 76.96, "10th_percentile": 75.51, "90th_percentile": 76.96, "count": "103" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 112.25, "10th_percentile": 89.8, "90th_percentile": 112.25, "count": "31" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 98.78, "10th_percentile": 98.78, "90th_percentile": 112.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRICHOMONAS VAGIN DIR PROBE", "code_information": [ { "code": "87660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.88, "discounted_cash": 20.0, "minimum": 19.4846, "maximum": 81.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 49.4, "10th_percentile": 41.5, "90th_percentile": 49.4, "count": "34" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.48, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 41.72, "10th_percentile": 41.72, "90th_percentile": 41.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 42.34, "10th_percentile": 42.34, "90th_percentile": 44.06, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 65.5, "10th_percentile": 49.4, "90th_percentile": 65.5, "count": "18" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 57.12, "10th_percentile": 57.12, "90th_percentile": 57.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MECHANICAL TRACTION THERAPY", "code_information": [ { "code": "97012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.38, "discounted_cash": 13.0, "minimum": 13.372, "maximum": 104.0994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US GUIDE FOR NEEDLE PLACEMENT", "code_information": [ { "code": "76942", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 985.0, "minimum": 248.6554, "maximum": 858.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 114.48, "10th_percentile": 114.48, "90th_percentile": 134.14, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.66 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 114.48, "10th_percentile": 114.48, "90th_percentile": 134.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 994.5, "10th_percentile": 994.5, "90th_percentile": 994.5, "count": "1 through 10" } ] } ] }, { "description": "HC ARC RBC PRETREATMENT,SERUM INHIB", "code_information": [ { "code": "86977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.88, "discounted_cash": 168.0, "minimum": 54.564, "maximum": 181.88, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 181.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC SHIGA-LIKE TOXIN AG EIA", "code_information": [ { "code": "87427", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.75, "discounted_cash": 11.0, "minimum": 11.625, "maximum": 38.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.4, "10th_percentile": 23.4, "90th_percentile": 23.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 18.63, "10th_percentile": 18.63, "90th_percentile": 18.63, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 20.05, "10th_percentile": 20.05, "90th_percentile": 20.85, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.4, "10th_percentile": 23.4, "90th_percentile": 31.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 25.74, "10th_percentile": 25.74, "90th_percentile": 62.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.44, "discounted_cash": 47.0, "minimum": 45.9467, "maximum": 155.5997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.43, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.95, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MNT SUBS TX FOR CHANGE DX", "code_information": [ { "code": "G0270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.31, "discounted_cash": 21.0, "minimum": 9.093, "maximum": 30.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEVELOPMENTAL SCREEN - G0451 - 44000053", "code_information": [ { "code": "G0451", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 449.06, "discounted_cash": 100.0, "minimum": 95.0, "maximum": 449.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 394.91, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 449.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 383.79, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 169.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC", "code_information": [ { "code": "21110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3811.88, "discounted_cash": 1530.0, "minimum": 1143.564, "maximum": 3811.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3811.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3811.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3811.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2589.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0200) CERV COL SUPP ADJ BAR & THOR", "code_information": [ { "code": "L0200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 645.0, "minimum": 627.0054, "maximum": 1091.1622, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 645.2, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 783.72, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 627.01, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 645.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 645.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 703.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 645.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 645.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 645.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1091.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Mycophenolate Sodium Tab DR 180 MG (Mycophenolic Acid Equiv)", "drug_information": { "unit": 120.0, "type": "EA" }, "code_information": [ { "code": "16729026129", "type": "NDC" }, { "code": "J7518", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R", "code_information": [ { "code": "91110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8482.81, "discounted_cash": 894.0, "minimum": 894.92, "maximum": 7397.0103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3525.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4282.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3426.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 250 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781320685", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0535, "maximum": 1.0535, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 15.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.84, "90th_percentile": 14.84, "count": "1 through 10" } ] } ] }, { "description": "HC EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION, 15 MIN", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 620.0, "discounted_cash": 56.0, "minimum": 54.9456, "maximum": 540.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.54, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.68, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 54.95, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 56.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 56.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 56.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 56.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.62, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMV F.B.,EYE,EMBED CONJUNC", "code_information": [ { "code": "65210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 494.38, "discounted_cash": 440.0, "minimum": 148.314, "maximum": 494.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 494.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 494.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 494.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 494.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOGRAM EXTREM BILAT", "code_information": [ { "code": "75822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3313.44, "discounted_cash": 1553.0, "minimum": 576.2288, "maximum": 3313.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3313.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3313.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3313.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 576.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11857.0, "minimum": 10168.82, "maximum": 49603.8588, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25682.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21624.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10168.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21624.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11857.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11420.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15807.24 } ] } ] }, { "description": "Amiodarone HCl in Dextrose 4.14% IV Soln 360 MG/200ML", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "43066036020", "type": "NDC" }, { "code": "J0282", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC DNA/RNA AMPLIFIED PROBE", "code_information": [ { "code": "87150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.25, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 192.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 286.22, "10th_percentile": 286.22, "90th_percentile": 286.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ETHOSUXIMIDE", "code_information": [ { "code": "80168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.19, "discounted_cash": 16.0, "minimum": 15.8792, "maximum": 57.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT MC-P DISLOC W MANIP W ANES", "code_information": [ { "code": "26705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2052.81, "discounted_cash": 1586.0, "minimum": 615.843, "maximum": 2052.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI SPECTROSCOPY", "code_information": [ { "code": "76390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2410.94, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 2410.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2410.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT RADIAL HEAD/NECK FX W MANIP", "code_information": [ { "code": "24655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 1586.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Propofol IV Emul 1000 MG/100ML (10 MG/ML)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "23155034533", "type": "NDC" }, { "code": "J2704", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC", "code_information": [ { "code": "824", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18278.0, "minimum": 15222.77, "maximum": 44661.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17581.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 40939.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17581.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17581.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44661.95 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18278.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15222.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18278.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44661.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17581.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18278.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17581.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25197.28 } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12158.7, "maximum": 12158.7, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12158.7 } ] } ] }, { "description": "HC (SUP SHELL Q4201) MATRION 1 SQ CM", "code_information": [ { "code": "Q4201", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 185.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SMEAR,INCLUSION BODIES/PARASITES,INTERP", "code_information": [ { "code": "87207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.38, "discounted_cash": 5.0, "minimum": 5.8211, "maximum": 82.2994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 57.0, "10th_percentile": 57.0, "90th_percentile": 57.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 57.93, "10th_percentile": 57.93, "90th_percentile": 57.93, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 31.33, "10th_percentile": 31.33, "90th_percentile": 31.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC", "code_information": [ { "code": "002", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 87230.0, "minimum": 65091.65, "maximum": 245069.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 83744.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 204763.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 83744.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 83744.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 245068.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 87230.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65091.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 87230.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 245069.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 83744.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 87230.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 83744.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 126028.65 } ] } ] }, { "description": "HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.25, "discounted_cash": 4.0, "minimum": 3.8872, "maximum": 88.29, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 51.6, "10th_percentile": 51.6, "90th_percentile": 51.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 55.53, "10th_percentile": 55.53, "90th_percentile": 55.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.88, "10th_percentile": 17.88, "90th_percentile": 17.88, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.76, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "346", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10069.0, "minimum": 8619.13, "maximum": 29297.7246, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9704.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21434.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9704.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 25625.43, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 19208.97, "10th_percentile": 19208.97, "90th_percentile": 35659.34, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9704.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21503.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10069.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8619.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10069.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21503.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9704.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10069.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9704.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13192.54 } ] } ] }, { "description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC", "code_information": [ { "code": "493", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20336.0, "minimum": 16618.11, "maximum": 70848.6596, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19555.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 45826.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19555.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19555.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 58978.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20336.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16618.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20336.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58978.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 70848.66, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4891.48, "10th_percentile": 4891.48, "90th_percentile": 4891.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19555.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20336.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19555.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28205.69 } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35746.0, "minimum": 33823.16, "maximum": 98670.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 82441.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 98670.12 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35746.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33823.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35746.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 98670.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 35746.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34343.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50741.55 } ] } ] }, { "description": "HC NONINVASV OXYGEN SATUT,CONTINUOUS", "code_information": [ { "code": "94762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.81, "discounted_cash": 126.0, "minimum": 54.843, "maximum": 182.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 182.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4358) URINARY LEG OR ABDOMEN BAG - A4358 - 27100046", "code_information": [ { "code": "A4358", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.1923, "maximum": 14.2568, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA", "code_information": [ { "code": "81382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1075.94, "discounted_cash": 123.0, "minimum": 120.1922, "maximum": 938.2197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 150.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 120.19, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 648.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 209.17, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3660) SO 8 AB RSTR CAN/WEB PRE OTS", "code_information": [ { "code": "L3660", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 154.0, "minimum": 149.7544, "maximum": 260.6139, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.19, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 149.75, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 167.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 260.61, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS - 98961 - 42998961", "code_information": [ { "code": "98961", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.69, "minimum": 28.407, "maximum": 94.69, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.69 } ] } ] }, { "description": "HC MED NUTR THER, 1ST, INDIV, EA 15 MIN", "code_information": [ { "code": "97802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.56, "discounted_cash": 25.0, "minimum": 24.8684, "maximum": 132.1603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.87, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.89, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EXCHANGE BILE DUCT CATH, PERQ", "code_information": [ { "code": "47536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15636.9, "discounted_cash": 3532.0, "minimum": 3532.78, "maximum": 15636.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13917.74, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15636.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13525.95, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CELLULAR FUNCTION ASSAY STIMUL&DETECT BIOMARKER", "code_information": [ { "code": "86352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.69, "discounted_cash": 135.0, "minimum": 128.907, "maximum": 429.69, "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 343.75, "10th_percentile": 343.75, "90th_percentile": 343.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 285.34, "10th_percentile": 285.34, "90th_percentile": 285.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.77, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 217.9, "10th_percentile": 217.9, "90th_percentile": 217.9, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 165.03, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 132.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 222.31, "10th_percentile": 222.31, "90th_percentile": 231.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Digoxin Immune Fab For Inj 40 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50633012011", "type": "NDC" }, { "code": "J1162", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5166.0, "minimum": 5022.4859, "maximum": 20355.8777, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20355.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6277.85, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5022.49, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10682.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5632.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5166.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8738.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Alprostadil Inj 500 MCG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00009316901", "type": "NDC" }, { "code": "J0270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.532, "maximum": 22.532, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.53 } ] } ] }, { "description": "HC REPR WND SMP FACE 7.6-12.5 CM", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 497.5, "discounted_cash": 197.0, "minimum": 149.25, "maximum": 497.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LARYNGOSCOPY, INDIRECT+REMV FOR.BODY", "code_information": [ { "code": "31511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.06, "discounted_cash": 196.0, "minimum": 68.718, "maximum": 229.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 229.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 229.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CASIRIVIMAB AND IMDEVIMAB INFUSION AND MONITORING", "code_information": [ { "code": "M0243", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 658.44, "discounted_cash": 435.0, "minimum": 197.532, "maximum": 658.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 658.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 658.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 658.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 474.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 658.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 60 MG/0.6ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00075062160", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.118, "maximum": 1.118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.12 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF ERYTHROPOIETIN", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 373.75, "discounted_cash": 18.0, "minimum": 18.2601, "maximum": 325.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 83.99, "10th_percentile": 83.99, "90th_percentile": 83.99, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 201.14, "10th_percentile": 201.14, "90th_percentile": 201.14, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 98.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 18.79, "10th_percentile": 18.79, "90th_percentile": 98.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC GATED HEART, MULTIPLE", "code_information": [ { "code": "78473", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2774.69, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 2419.5297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1553.98, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1887.72, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1763.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CCMCC", "code_information": [ { "code": "458", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32782.0, "minimum": 29886.3, "maximum": 85532.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75398.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 85532.42 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32782.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29886.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32782.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 85532.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 32782.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31498.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46406.32 } ] } ] }, { "description": "HC THYROID MET UPTAKE", "code_information": [ { "code": "78020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 537.5, "minimum": 161.25, "maximum": 468.7, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 459.27 } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37255.0, "minimum": 7411.51, "maximum": 86026.8943, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35791.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 86026.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 35791.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 74066.28, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 154805.91, "10th_percentile": 154805.91, "90th_percentile": 154805.91, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35791.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 7411.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37255.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32562.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37255.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7411.51 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35791.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 37255.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35791.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52948.09 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "661", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8922.0, "minimum": 7105.44, "maximum": 28342.3576, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25514.62, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22080.26, "10th_percentile": 22080.26, "90th_percentile": 22080.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18709.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 24789.81, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15754.75, "10th_percentile": 15754.75, "90th_percentile": 15754.75, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22971.01 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8922.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7105.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8922.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22971.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8922.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11515.39 } ] } ] }, { "description": "HC EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2177.81, "discounted_cash": 698.0, "minimum": 653.343, "maximum": 2177.81, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2177.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2177.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2177.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HC DRUG SCREEN QUANTITATIVE LAMOTRIGINE", "code_information": [ { "code": "80175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 329.69, "discounted_cash": 13.0, "minimum": 12.8764, "maximum": 287.4897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 199.0, "10th_percentile": 199.0, "90th_percentile": 199.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 218.9, "10th_percentile": 69.53, "90th_percentile": 229.99, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A2012) SUPRATHEL, PER SQ CM", "code_information": [ { "code": "A2012", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4608) TRANSTRACHEAL OXYGEN CATH", "code_information": [ { "code": "A4608", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 71.0, "minimum": 69.4254, "maximum": 120.8193, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.44, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.78, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF FOLIC ACID, RBC", "code_information": [ { "code": "82747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.75, "discounted_cash": 17.0, "minimum": 17.1523, "maximum": 225.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1398.13, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1219.1694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 844.2, "10th_percentile": 844.2, "90th_percentile": 844.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 820.35, "10th_percentile": 820.35, "90th_percentile": 820.35, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 690.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 305.48, "10th_percentile": 305.48, "90th_percentile": 844.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 975.33, "10th_percentile": 975.33, "90th_percentile": 975.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IADNA ENTEROVIRUS AMPLIF PROBE & REV TRNSCRIP", "code_information": [ { "code": "87498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.0, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 396.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC", "code_information": [ { "code": "155", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8018.0, "minimum": 6461.75, "maximum": 18181.3918, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7736.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16561.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7736.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7736.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11896.61 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8018.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6461.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8018.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11896.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7736.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8018.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7736.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10193.02 } ] } ] }, { "description": "HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST", "code_information": [ { "code": "94726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1475.31, "discounted_cash": 368.0, "minimum": 368.19, "maximum": 1475.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 167.2, "10th_percentile": 167.2, "90th_percentile": 167.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1450.52, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1475.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1409.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 160.72, "10th_percentile": 160.72, "90th_percentile": 167.48, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 167.41, "10th_percentile": 162.48, "90th_percentile": 900.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 160.22, "10th_percentile": 160.22, "90th_percentile": 168.27, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 165.53, "10th_percentile": 165.53, "90th_percentile": 165.53, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 401.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 183.92, "10th_percentile": 183.92, "90th_percentile": 1029.18, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THAW PLASMA FRESH FROZEN EA UNIT - 86927 - 30200150", "code_information": [ { "code": "86927", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1036.88, "discounted_cash": 168.0, "minimum": 123.5191, "maximum": 904.1594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 662.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 804.48, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 643.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "723", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9738.0, "minimum": 7771.96, "maximum": 24712.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9387.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20648.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9387.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9387.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24712.83 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9738.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7771.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9738.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24712.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9387.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9738.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9387.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12708.74 } ] } ] }, { "description": "RESPIRATORY NEOPLASMS WITH CC", "code_information": [ { "code": "181", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9193.0, "minimum": 7684.75, "maximum": 22431.0195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19352.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21829.27 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9193.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7684.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9193.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21829.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9193.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8863.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11911.32 } ] } ] }, { "description": "Heparin Sodium (Porcine)-Dextrose IV Sol 25000 Unit/500ML-5%", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "63323052201", "type": "NDC" }, { "code": "j1644", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 14.48, "10th_percentile": 11.99, "90th_percentile": 68.71, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 16.2, "count": "1 through 10" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13249.0, "minimum": 10697.61, "maximum": 46443.5397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12755.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28989.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12755.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12755.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34405.85 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10697.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34405.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12755.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12755.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17842.51 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27571.0, "minimum": 26498.1, "maximum": 68324.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26498.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 63016.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26498.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26498.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 68324.62 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 27571.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26750.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27571.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68324.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26498.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 27571.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26498.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38785.75 } ] } ] }, { "description": "HC (SUP SHELL A5063) DRAIN OSTOMY POUCH W/FLANGE", "code_information": [ { "code": "A5063", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.7511, "maximum": 6.528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.75, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT IP JNT DISLOC W MANIP W ANES", "code_information": [ { "code": "26775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2052.81, "discounted_cash": 275.0, "minimum": 275.97, "maximum": 1790.0503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1087.21, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1320.71, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1056.61, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 466.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC", "code_information": [ { "code": "011", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42528.0, "minimum": 37346.8, "maximum": 148183.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40850.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 98554.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 40850.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 40850.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 148183.45 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 42528.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37346.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42528.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 148183.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40850.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 42528.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40850.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 60658.75 } ] } ] }, { "description": "HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS", "code_information": [ { "code": "33230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118780.0, "discounted_cash": 21947.0, "minimum": 21947.8, "maximum": 105035.5865, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86465.55, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105035.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84031.54, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23923.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37118.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NERVOUS SYSTEM NEOPLASMS WITHOUT MCC", "code_information": [ { "code": "055", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8802.0, "minimum": 7551.17, "maximum": 31138.2567, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8488.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18424.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8488.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8488.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16995.43 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8802.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7551.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8802.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16995.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8488.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8802.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8488.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11339.66 } ] } ] }, { "description": "HC FETAL NON-STRESS TEST", "code_information": [ { "code": "59025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 605.63, "minimum": 181.689, "maximum": 528.1094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 310.13, "10th_percentile": 310.13, "90th_percentile": 310.13, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 365.51, "10th_percentile": 365.51, "90th_percentile": 380.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 140.58, "10th_percentile": 84.26, "90th_percentile": 146.28, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L8613) OSSICULAR IMPLANT", "code_information": [ { "code": "L8613", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 382.0, "minimum": 371.7135, "maximum": 646.884, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 382.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 464.62, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 371.71, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 382.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 382.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 382.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 382.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOUS SAMPLING BY CATHETER", "code_information": [ { "code": "75893", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1848.44, "discounted_cash": 5490.0, "minimum": 554.532, "maximum": 1848.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 702.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1848.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Azithromycin Tab 500 MG", "drug_information": { "unit": 30.0, "type": "EA" }, "code_information": [ { "code": "00904735104", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.1585, "maximum": 54.1585, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.16 } ] } ] }, { "description": "HC X-RAY OPER CHOLANGIOGRAM", "code_information": [ { "code": "74300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1267.5, "minimum": 210.6133, "maximum": 1105.26, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 777.33, "10th_percentile": 777.33, "90th_percentile": 777.33, "count": "1 through 10" } ] } ] }, { "description": "HC SLP STUDY, UNATND, RCRD HRT RATE/O2 SAT/RSP ANAL/SLP TM - G0400 - 74000031", "code_information": [ { "code": "G0400", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 641.88, "discounted_cash": 213.0, "minimum": 192.564, "maximum": 641.88, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 641.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 641.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 641.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6630.0, "minimum": 1874.9172, "maximum": 13263.2626, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6404.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13263.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6404.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6404.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12031.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6630.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5246.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6630.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12031.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6404.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6630.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6404.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8163.31 } ] } ] }, { "description": "HC (SUP SHELL A6223) GAUZE >16<=48 NO W/SAL W/O B - A6223 - RU272048", "code_information": [ { "code": "A6223", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.3624, "maximum": 5.8516, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.36, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylnaltrexone Bromide Inj 12 MG/0.6ML (20 MG/ML)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "65649055103", "type": "NDC" }, { "code": "J2212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.1175, "maximum": 3.1175, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.12 } ] } ] }, { "description": "HC (SUP SHELL C1713) ANCHR/SCREW OPPOS BN-BN/SFT TISS-BN", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1837.13, "10th_percentile": 167.83, "90th_percentile": 8101.3, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 5525.18, "10th_percentile": 856.89, "90th_percentile": 10313.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1615.03, "10th_percentile": 1615.03, "90th_percentile": 1615.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 10738.86, "10th_percentile": 6886.62, "90th_percentile": 17515.52, "count": "1 through 10" } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC", "code_information": [ { "code": "178", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8470.0, "minimum": 6866.65, "maximum": 26606.9729, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8170.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17636.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8170.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8170.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14616.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8470.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6866.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8470.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14616.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8170.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8470.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8170.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10854.76 } ] } ] }, { "description": "HC ASSAY OF PROINSULIN", "code_information": [ { "code": "84206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.31, "discounted_cash": 26.0, "minimum": 25.9373, "maximum": 222.6303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.42, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.94, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prochlorperazine Maleate Tab 5 MG (Base Equivalent)", "drug_information": { "unit": 50.0, "type": "EA" }, "code_information": [ { "code": "00904738106", "type": "NDC" }, { "code": "Q0164", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC HCV RNA, PCR, QUALITATIVE", "code_information": [ { "code": "87521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 491.25, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 428.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEPATITIS B , DNA, QUANT", "code_information": [ { "code": "87517", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 806.56, "discounted_cash": 42.0, "minimum": 41.6319, "maximum": 703.3203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 409.08, "10th_percentile": 409.08, "90th_percentile": 409.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.04, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 434.06, "10th_percentile": 417.36, "90th_percentile": 434.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 224.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 535.7, "10th_percentile": 224.79, "90th_percentile": 562.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8038.0, "minimum": 6380.08, "maximum": 25564.7728, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7755.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16607.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7755.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 22430.74, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 21414.8, "10th_percentile": 21414.8, "90th_percentile": 21414.8, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7755.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20601.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8038.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6380.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8038.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20601.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 25564.77, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11352.79, "10th_percentile": 11352.79, "90th_percentile": 36830.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7755.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8038.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7755.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10221.94 } ] } ] }, { "description": "Influenza Virus Vaccine Split PF Susp Pref Syringe 0.5 ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "49281042588", "type": "NDC" }, { "code": "90686", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 19.1736, "maximum": 48.0525, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.05 } ] } ] }, { "description": "SPINAL PROCEDURES WITH MCC", "code_information": [ { "code": "028", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46743.0, "minimum": 42078.23, "maximum": 108569.0197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44895.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 108569.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 44895.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 44895.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 88573.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 46743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42078.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 88573.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 44895.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 46743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44895.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66822.39 } ] } ] }, { "description": "HC BLOOD CLOT FACTOR X TEST", "code_information": [ { "code": "85260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.94, "discounted_cash": 17.0, "minimum": 17.3952, "maximum": 358.3397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.74, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4193) COLL-E-DERM 1 SQ CM", "code_information": [ { "code": "Q4193", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 3457.7805, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3457.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Amikacin Sulfate Inj 1 GM/4ML (250 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "23155029031", "type": "NDC" }, { "code": "J0278", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.29, "maximum": 1.29, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.29 } ] } ] }, { "description": "HC CLSD TREAT ULNAR FX PROX END W MANIP", "code_information": [ { "code": "24675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 473.75, "discounted_cash": 1586.0, "minimum": 142.125, "maximum": 473.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 473.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC WASHED RED BLOOD CELLS, PER UNIT", "code_information": [ { "code": "P9022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2315.94, "discounted_cash": 366.0, "minimum": 311.064, "maximum": 2019.4997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1444.93, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1755.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1404.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 399.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 620.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC POS AIRWAY PRESSURE, CPAP", "code_information": [ { "code": "94660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 685.0, "discounted_cash": 216.0, "minimum": 205.5, "maximum": 685.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 685.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 685.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 685.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 235.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 365.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY EXAM OF FINGER(S)", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 393.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 393.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 199.58, "10th_percentile": 199.58, "90th_percentile": 199.58, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 393.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 230.89, "10th_percentile": 230.89, "90th_percentile": 240.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 277.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 125.03, "10th_percentile": 125.03, "90th_percentile": 125.03, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 274.46, "10th_percentile": 241.29, "90th_percentile": 274.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT RAD/ULNA SHAFT FX W MANIP", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 443.44, "discounted_cash": 1586.0, "minimum": 133.032, "maximum": 443.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3332) SHOE LIFTS TAPERED TO ONE-HA", "code_information": [ { "code": "L3332", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 88.0, "minimum": 85.9557, "maximum": 149.5866, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.44, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.96, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.41, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 149.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SELF CARE MNGMENT TRAIN COMPLEX EA 15 MIN", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.44, "discounted_cash": 30.0, "minimum": 30.0383, "maximum": 142.5197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 175.73, "10th_percentile": 175.73, "90th_percentile": 175.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.55, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.04, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6449) LT COMPRES BAND >=3 <5/YD - A6449 - 27100025", "code_information": [ { "code": "A6449", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4295, "maximum": 4.228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BILE TRACT SURG PROC, UNLISTED", "code_information": [ { "code": "47999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3442.81, "discounted_cash": 894.0, "minimum": 894.92, "maximum": 3442.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3442.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3442.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3426.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF MYOGLOBIN", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.13, "discounted_cash": 12.0, "minimum": 12.5557, "maximum": 159.6894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.69, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTRAOPERATIVE CYTO PATH CONSULT, INITIAL SITE", "code_information": [ { "code": "88333", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.13, "discounted_cash": 794.0, "minimum": 66.939, "maximum": 223.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 223.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Tet Tox-Diph-Acell Pertuss Ad Inj 5-2-15.5 LF-LF-MCG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "49281040058", "type": "NDC" }, { "code": "90715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 84.0005, "maximum": 84.0005, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 224.62, "10th_percentile": 224.62, "90th_percentile": 224.62, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 259.85, "10th_percentile": 259.85, "90th_percentile": 268.71, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 279.03, "10th_percentile": 279.03, "90th_percentile": 279.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 307.21, "10th_percentile": 307.21, "90th_percentile": 307.21, "count": "1 through 10" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "143", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29542.0, "minimum": 22853.54, "maximum": 67700.4625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28389.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 67700.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28389.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28389.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27216.45 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 29542.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22853.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29542.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27216.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28389.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 29542.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28389.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41668.49 } ] } ] }, { "description": "HC CONVERT NEPHROSTOMY CATHETER", "code_information": [ { "code": "50434", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2613.44, "discounted_cash": 2062.0, "minimum": 784.032, "maximum": 2613.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2613.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2613.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2613.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2613.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI PELVIS W/CONTRAST", "code_information": [ { "code": "72196", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2698.75, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2353.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1714.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB", "code_information": [ { "code": "33273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8889.06, "discounted_cash": 3687.0, "minimum": 2666.718, "maximum": 8889.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8889.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8889.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8889.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4019.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6235.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT CLAVICLE FX W MANIP", "code_information": [ { "code": "23505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.94, "discounted_cash": 1586.0, "minimum": 90.282, "maximum": 300.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4425) OST PCH DRAIN FOR BARRIER FL", "code_information": [ { "code": "A4425", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 4.9562, "maximum": 8.6251, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Micafungin Sodium For IV Soln 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "71288002910", "type": "NDC" }, { "code": "J2248", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC EEG EVAL CEREBRAL DEATH", "code_information": [ { "code": "95824", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1119.06, "discounted_cash": 368.0, "minimum": 335.718, "maximum": 1119.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1119.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1119.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1119.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 401.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4116) ALLODERM", "code_information": [ { "code": "Q4116", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 66.8865, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYSTOSCOPY,REMV CALCULUS,SIMPLE", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9391.56, "discounted_cash": 2062.0, "minimum": 2062.58, "maximum": 9391.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8125.74, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9391.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7897.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMHISTOCHEM/CYTCHM EA ADD SEP IDENT ANTIBODY SLIDE", "code_information": [ { "code": "88341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 444.69, "minimum": 133.407, "maximum": 413.7942, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 682.92, "10th_percentile": 682.92, "90th_percentile": 2048.76, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 232.25, "10th_percentile": 227.88, "90th_percentile": 696.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 413.79 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 273.25, "10th_percentile": 129.16, "90th_percentile": 1639.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 338.75, "10th_percentile": 295.39, "90th_percentile": 1343.22, "count": "16" } ] } ] }, { "description": "HC ASSAY OF PHENYTOIN, FREE", "code_information": [ { "code": "80186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.06, "discounted_cash": 13.0, "minimum": 13.372, "maximum": 64.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prochlorperazine Edisylate Inj 10 MG/2ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "23155029431", "type": "NDC" }, { "code": "J0780", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.278, "maximum": 6.278, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.28 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 33.76, "10th_percentile": 33.76, "90th_percentile": 33.76, "count": "1 through 10" } ] } ] }, { "description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC", "code_information": [ { "code": "067", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12218.0, "minimum": 10069.84, "maximum": 31763.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11766.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26539.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11766.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11766.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31763.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12218.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10069.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12218.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31763.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11766.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12218.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11766.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16334.41 } ] } ] }, { "description": "Calcium Gluconate-NaCl IV Soln 1 GM/50ML-0.675% (20 MG/ML)", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "44567062001", "type": "NDC" }, { "code": "J0612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A4371) SKIN BARRIER POWDER PER OZ", "code_information": [ { "code": "A4371", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 5.0534, "maximum": 8.7942, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.32, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1960) AFO POS SOLID ANK PLASTIC MO", "code_information": [ { "code": "L1960", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 849.0, "minimum": 825.3109, "maximum": 1436.2685, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 849.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 849.26, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1031.6, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 849.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 825.31, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 849.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 849.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 849.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 925.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 849.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 849.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 849.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 849.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 849.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1436.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3", "code_information": [ { "code": "84480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.38, "discounted_cash": 14.0, "minimum": 13.7801, "maximum": 169.4994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 124.4, "10th_percentile": 104.5, "90th_percentile": 124.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.22, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 99.05, "10th_percentile": 14.15, "90th_percentile": 99.05, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 104.6, "10th_percentile": 104.6, "90th_percentile": 106.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 124.4, "10th_percentile": 63.38, "90th_percentile": 124.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 136.84, "10th_percentile": 135.59, "90th_percentile": 136.84, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Sincalide For Inj 5 MCG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "72266024805", "type": "NDC" }, { "code": "J2805", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 308.009, "maximum": 308.009, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 246.96, "10th_percentile": 246.96, "90th_percentile": 246.96, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 308.01 } ] } ] }, { "description": "HC BLOOD METHEMOGLOBIN, QUANT", "code_information": [ { "code": "83050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.19, "discounted_cash": 8.0, "minimum": 7.9688, "maximum": 123.9897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.96, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Atropine Sulfate Soln Prefill Syr 0.5 MG/5ML (0.1 MG/ML)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "64253040030", "type": "NDC" }, { "code": "J0461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 19.41, "10th_percentile": 19.41, "90th_percentile": 19.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC REPR WND SMP BODY/SCALP/EXTR 2.6-7.5 CM", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 497.5, "discounted_cash": 197.0, "minimum": 149.25, "maximum": 497.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 347.06, "10th_percentile": 347.06, "90th_percentile": 347.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND CPLX TRNK 2.6-7.5 CM", "code_information": [ { "code": "13101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2362.81, "discounted_cash": 729.0, "minimum": 708.843, "maximum": 2362.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MAMMOGRAPHY; BILATERAL", "code_information": [ { "code": "77066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 753.44, "discounted_cash": 101.0, "minimum": 98.6474, "maximum": 753.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 482.2, "10th_percentile": 482.2, "90th_percentile": 482.2, "count": "12" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 101.51, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.3, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 98.65, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 382.14, "10th_percentile": 382.14, "90th_percentile": 382.14, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 468.58, "10th_percentile": 459.72, "90th_percentile": 468.58, "count": "25" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 753.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 101.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 441.46, "10th_percentile": 441.46, "90th_percentile": 482.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 101.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 101.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 525.6, "10th_percentile": 462.07, "90th_percentile": 530.42, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 101.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.67, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "761", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5386.0, "minimum": 4387.43, "maximum": 10308.8437, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4387.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5386.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8268.78 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5211.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5386.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5211.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6344.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5211.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 10308.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5211.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5211.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8268.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5386.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VASOPRESSIN", "code_information": [ { "code": "84588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 675.94, "discounted_cash": 33.0, "minimum": 32.9829, "maximum": 589.4197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.23, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.98, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF THYROGLOBULIN", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.25, "discounted_cash": 16.0, "minimum": 15.6071, "maximum": 253.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 186.4, "10th_percentile": 186.4, "90th_percentile": 186.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 159.74, "10th_percentile": 159.74, "90th_percentile": 159.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 205.04, "10th_percentile": 205.04, "90th_percentile": 205.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMHISTOCHEM/CYTCHM 1ST SEP IDENT ANTIBODY SLIDE", "code_information": [ { "code": "88342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 423.44, "discounted_cash": 168.0, "minimum": 127.032, "maximum": 423.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 227.64, "10th_percentile": 227.64, "90th_percentile": 227.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 423.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 423.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 423.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 215.78, "10th_percentile": 215.78, "90th_percentile": 431.57, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 232.25, "10th_percentile": 227.88, "90th_percentile": 683.63, "count": "21" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 423.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 311.16, "10th_percentile": 64.42, "90th_percentile": 311.16, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 298.1, "10th_percentile": 295.39, "90th_percentile": 510.45, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI UPPER EXTREMITY W/CONTRAST", "code_information": [ { "code": "73219", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2698.75, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2353.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2325.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC AMPUTATION OF FINGER/THUMB", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8466.56, "discounted_cash": 3228.0, "minimum": 2539.968, "maximum": 8466.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8466.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8466.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8466.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8630) METACARPOPHALANGEAL IMPLANT", "code_information": [ { "code": "L8630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 549.0, "minimum": 534.4317, "maximum": 930.0585, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 549.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 549.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 668.01, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 549.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 534.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 549.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 549.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 549.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 599.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 549.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 549.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 549.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 549.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 549.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 930.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY URETHROCYSTOGRAM", "code_information": [ { "code": "74450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1323.75, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1154.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 450.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT TUNNLD CV CATH W 2 ACSS SITES W PUMP/PORT", "code_information": [ { "code": "36566", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26842.5, "discounted_cash": 5490.0, "minimum": 5490.48, "maximum": 26275.7901, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21630.3, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26275.79, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21021.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM LIVER & SPLEEN IMAGE, FLOW", "code_information": [ { "code": "78216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 774.38, "discounted_cash": 394.0, "minimum": 232.314, "maximum": 774.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 774.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 774.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 774.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 774.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT PST MALLEOLUS FX W MANIP", "code_information": [ { "code": "27768", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6216.88, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 6216.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6216.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6216.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6074.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ NERV BLCK, PUDENDAL", "code_information": [ { "code": "64430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3672.81, "discounted_cash": 872.0, "minimum": 872.7, "maximum": 3672.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3438.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3672.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3341.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC", "code_information": [ { "code": "456", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 64959.0, "minimum": 58618.13, "maximum": 151848.0935, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 62373.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 151848.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 62373.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 62373.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 131316.62 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 64959.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58618.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 64959.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 131317.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 62373.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 64959.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 62373.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 93459.93 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 75449.0, "minimum": 66798.45, "maximum": 234974.3084, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 72440.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 176773.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 72440.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 72440.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 203122.93 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 75449.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66798.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 75449.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 203123.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 72440.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 75449.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 72440.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 108801.17 } ] } ] }, { "description": "Azathioprine Tab 50 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68084022911", "type": "NDC" }, { "code": "J7500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.1715, "maximum": 2.1715, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.17 } ] } ] }, { "description": "HC INJ NEPHROSTOGRA/URETEROGRAM", "code_information": [ { "code": "50430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2351.88, "discounted_cash": 688.0, "minimum": 688.02, "maximum": 2351.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2351.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2351.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2351.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 749.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1163.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L2795) KNEE CONTROL FULL KNEECAP", "code_information": [ { "code": "L2795", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 130.0, "minimum": 126.5186, "maximum": 220.1773, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 130.19, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.14, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 130.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 130.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 130.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 220.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Promethazine HCl Tab 25 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904730461", "type": "NDC" }, { "code": "Q0169", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "RENAL FAILURE WITH MCC", "code_information": [ { "code": "682", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12311.0, "minimum": 10395.15, "maximum": 30563.6099, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11856.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26761.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11856.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11856.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22943.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12311.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10395.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12311.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22943.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11856.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12311.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11856.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16471.21 } ] } ] }, { "description": "HC DRAIN/INJECT SMALL JOINT/BURSA", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.38, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1179.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1179.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1159.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 546.59, "10th_percentile": 546.59, "90th_percentile": 546.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MR ANGIO, HEAD, COMBO", "code_information": [ { "code": "70546", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3685.63, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 3213.8694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2372.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3931) WHFO NONTORSION JOINT PREFAB", "code_information": [ { "code": "L3931", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 232.0, "minimum": 225.5256, "maximum": 392.4768, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 232.07, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 281.9, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 225.53, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 232.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 232.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 232.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 232.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 392.48, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR MALE PELVIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "708", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12716.0, "minimum": 10260.87, "maximum": 43428.4651, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12244.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27722.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12244.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12244.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41488.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12716.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10260.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12716.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41488.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12244.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12716.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12244.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17062.88 } ] } ] }, { "description": "HC X-RAY PELVIS 3+ VW", "code_information": [ { "code": "72190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 616.88, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 537.9194, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HC PHOSPHATIDYLGLYCEROL", "code_information": [ { "code": "84081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.56, "discounted_cash": 16.0, "minimum": 16.0541, "maximum": 206.2803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LF/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "49281021588", "type": "NDC" }, { "code": "90714", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 73.014, "maximum": 73.014, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.01 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 143.15, "10th_percentile": 143.15, "90th_percentile": 143.15, "count": "1 through 10" } ] } ] }, { "description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC", "code_information": [ { "code": "923", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8788.0, "minimum": 7059.06, "maximum": 30734.2264, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18389.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9611.2 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8788.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7059.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8788.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9611.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8788.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8474.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11318.53 } ] } ] }, { "description": "HC CLSD TREAT DISTL RAD/ULNA FX W MANIP", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 945.31, "discounted_cash": 1586.0, "minimum": 283.593, "maximum": 945.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 945.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY", "code_information": [ { "code": "36226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15017.2, "discounted_cash": 5490.0, "minimum": 4505.16, "maximum": 15017.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15017.2, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15017.2, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15017.2, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASPERGILLUS ANTIBODY", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.56, "discounted_cash": 15.0, "minimum": 14.6256, "maximum": 228.0803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+", "code_information": [ { "code": "71270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3931.56, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 3428.3203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1254.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC APPLY ELBOW TO FINGER CAST", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1297.19, "discounted_cash": 275.0, "minimum": 275.97, "maximum": 1297.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1087.21, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1297.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1056.61, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 466.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM TUMOR IMAGING SPECT", "code_information": [ { "code": "78803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6184.69, "discounted_cash": 535.0, "minimum": 535.74, "maximum": 5393.0497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2110.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2563.89, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2051.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2614.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD CLOT FACTOR VIII TEST, ONE STAGE", "code_information": [ { "code": "85240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.38, "discounted_cash": 17.0, "minimum": 17.3952, "maximum": 143.3394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 80.01, "10th_percentile": 80.01, "90th_percentile": 80.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.74, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 114.67, "10th_percentile": 114.67, "90th_percentile": 114.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL OF SALIVARY STONE", "code_information": [ { "code": "42330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10141.6, "discounted_cash": 3271.0, "minimum": 3042.48, "maximum": 10141.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5532.54, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10141.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10141.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10141.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3565.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC TRICHINELLA ANTIBODY", "code_information": [ { "code": "86784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.44, "discounted_cash": 12.0, "minimum": 12.2058, "maximum": 173.0397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES", "code_information": [ { "code": "64647", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3280.94, "discounted_cash": 696.0, "minimum": 696.49, "maximum": 3280.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3280.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HISTOCHEMICAL STAIN", "code_information": [ { "code": "88314", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.75, "minimum": 65.625, "maximum": 218.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.75 } ] } ] }, { "description": "HC TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY", "code_information": [ { "code": "35302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11003.1, "minimum": 3300.93, "maximum": 11003.1, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11003.1 } ] } ] }, { "description": "Midazolam HCl Oral/Rectal/Inj 5 MG/5ML (Base Equivalent)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409000101", "type": "NDC" }, { "code": "J2250", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 30.26, "10th_percentile": 30.26, "90th_percentile": 30.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "ORBITAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "114", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11338.0, "minimum": 8181.7, "maximum": 29260.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10921.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24448.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10921.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10921.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29260.27 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11338.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8181.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11338.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29260.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10921.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11338.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10921.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15047.63 } ] } ] }, { "description": "HC LEVEEN/SHUNT PATENCY EXAM", "code_information": [ { "code": "78291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1046.25, "discounted_cash": 394.0, "minimum": 313.875, "maximum": 1046.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1046.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1046.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1046.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RADIOREQUENCY BONE TUMOR ABLATION, PERQ", "code_information": [ { "code": "20982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10920.6, "discounted_cash": 17300.0, "minimum": 3276.18, "maximum": 10920.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10920.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DNA ANTIBODY, SINGLE STRAND", "code_information": [ { "code": "86226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.94, "discounted_cash": 12.0, "minimum": 11.7685, "maximum": 166.4997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPOSITION VENOUS CATHETER", "code_information": [ { "code": "36597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1365.31, "discounted_cash": 1553.0, "minimum": 409.593, "maximum": 1365.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1365.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RBC SICKLE CELL TEST", "code_information": [ { "code": "85660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 460.0, "discounted_cash": 5.0, "minimum": 5.3546, "maximum": 401.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.69, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATIO", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1009.06, "minimum": 302.718, "maximum": 879.9003, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 356.83 } ] } ] }, { "description": "Acyclovir Sodium IV Soln 50 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "55150015410", "type": "NDC" }, { "code": "J0133", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ASSAY OF INSULIN,TOTAL", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.44, "discounted_cash": 11.0, "minimum": 11.1077, "maximum": 199.1997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 146.2, "10th_percentile": 146.2, "90th_percentile": 146.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.88, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 122.94, "10th_percentile": 122.94, "90th_percentile": 125.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 159.36, "10th_percentile": 59.78, "90th_percentile": 160.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7669.0, "minimum": 6097.0, "maximum": 23731.6282, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7401.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15731.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7401.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7401.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17318.85 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7669.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6097.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7669.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17318.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7401.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7669.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7401.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9682.53 } ] } ] }, { "description": "HC X-RAY KNEE 1 OR 2 VIEW", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.38, "discounted_cash": 85.0, "minimum": 65.814, "maximum": 219.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 219.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 219.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 104.93, "10th_percentile": 104.93, "90th_percentile": 104.93, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 128.66, "10th_percentile": 128.66, "90th_percentile": 133.85, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 102.59, "10th_percentile": 102.59, "90th_percentile": 132.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 145.64, "10th_percentile": 134.54, "90th_percentile": 153.04, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 132.4, "10th_percentile": 111.22, "90th_percentile": 132.4, "count": "1 through 10" } ] } ] }, { "description": "HC INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM", "code_information": [ { "code": "93288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.31, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 279.3103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY TOTAL HYDROXYPROLINE", "code_information": [ { "code": "83505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 479.69, "discounted_cash": 24.0, "minimum": 23.6147, "maximum": 418.2897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.52, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY ABDOMEN 2 VW", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 769.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 670.6203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 464.4, "10th_percentile": 464.4, "90th_percentile": 464.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 451.28, "10th_percentile": 451.28, "90th_percentile": 469.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT CANNULA,VEIN-VEIN", "code_information": [ { "code": "36800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22044.1, "discounted_cash": 5490.0, "minimum": 5490.48, "maximum": 22044.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21630.3, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22044.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21021.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6454) SELF-ADHER BAND W>=3 <5/YD - A6454 - 27100029", "code_information": [ { "code": "A6454", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.0884, "maximum": 1.8941, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.09, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SLCTV CATH INTRNL CAROTD ART ANGIO INTRCRNL ART", "code_information": [ { "code": "36224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15017.2, "discounted_cash": 5490.0, "minimum": 4505.16, "maximum": 15017.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15017.2, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15017.2, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15017.2, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CCMCC", "code_information": [ { "code": "488", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14501.0, "minimum": 13603.18, "maximum": 107536.6358, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13957.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31963.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13957.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13957.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27444.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14501.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13603.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14501.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27444.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13957.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14501.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13957.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19673.14 } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC", "code_information": [ { "code": "843", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16219.0, "minimum": 13104.15, "maximum": 36703.0468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36045.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24291.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16219.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13104.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16219.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24292.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16219.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15605.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22185.53 } ] } ] }, { "description": "HC MORPH INSITU HYBRIDIZE MANL PER SPCMN, INIT SING PROB STAIN", "code_information": [ { "code": "88368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1868.13, "discounted_cash": 353.0, "minimum": 353.68, "maximum": 1692.6064, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1393.36, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1692.61, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1354.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 697.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 385.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 598.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT", "code_information": [ { "code": "93451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC", "code_information": [ { "code": "021", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41309.0, "minimum": 36966.13, "maximum": 115964.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39680.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 95658.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 39680.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 39680.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 115963.65 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 41309.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36966.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41309.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 115964.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39680.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 41309.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39680.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58875.95 } ] } ] }, { "description": "HC (SUP SHELL L3919) HO W/O JOINTS CF", "code_information": [ { "code": "L3919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 295.0, "minimum": 287.3224, "maximum": 500.0202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 359.14, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 287.32, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 322.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 500.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MECH REMOV INTRALUM OBSTR CV DEV THRU LUMEN", "code_information": [ { "code": "36596", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1414.38, "discounted_cash": 1553.0, "minimum": 424.314, "maximum": 1414.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1414.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HLA TYPING, A,B,OR C /MULTI", "code_information": [ { "code": "86813", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 685.31, "discounted_cash": 58.0, "minimum": 56.3644, "maximum": 597.5903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.45, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 56.36, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC", "code_information": [ { "code": "154", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12939.0, "minimum": 11256.16, "maximum": 28252.1948, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12458.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28252.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12458.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12458.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18129.37 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12939.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11256.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12939.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18129.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12458.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12939.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12458.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17388.75 } ] } ] }, { "description": "HC VASC EMB/OCC W/PRS CATH", "code_information": [ { "code": "C9797", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55798.1, "discounted_cash": 18087.0, "minimum": 16739.43, "maximum": 55798.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55798.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55798.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55798.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hydromorphone HCl Preservative Free (PF) Inj 10 MG/ML - 00409263450", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00409263450", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.98, "10th_percentile": 11.99, "90th_percentile": 39.11, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 44.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "316", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6235.0, "minimum": 4725.19, "maximum": 13681.7716, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6025.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12325.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6025.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6025.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11861.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6235.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6235.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11861.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6025.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6235.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6025.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7586.1 } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS", "code_information": [ { "code": "870", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53614.0, "minimum": 48148.23, "maximum": 167742.8612, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 51488.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 124895.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 51488.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 51488.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 154057.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 53614.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48148.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53614.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 154058.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 167742.86, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 10308.42, "10th_percentile": 10308.42, "90th_percentile": 10308.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 51488.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 53614.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 51488.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 76870.83 } ] } ] }, { "description": "HC DEXA,BONE DENSITY,VERTEB FRACT", "code_information": [ { "code": "77085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 564.38, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 345.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9612.0, "minimum": 7881.32, "maximum": 51302.8544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9266.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20348.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9266.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 43654.49, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 32742.17, "10th_percentile": 32742.17, "90th_percentile": 32742.17, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 44872.35, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 53398.6, "10th_percentile": 53398.6, "90th_percentile": 53398.6, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9266.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32223.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9612.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7881.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9612.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32223.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9266.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9612.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9266.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12524.12 } ] } ] }, { "description": "HC CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX", "code_information": [ { "code": "51045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3447.5, "discounted_cash": 2062.0, "minimum": 1034.25, "maximum": 3447.5, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3447.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3447.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3447.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3447.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ART", "code_information": [ { "code": "36225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9181.88, "discounted_cash": 3115.0, "minimum": 2754.564, "maximum": 9181.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6167.0, "minimum": 4653.9, "maximum": 25936.0896, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5960.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12164.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5960.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 22756.54, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 26834.21, "10th_percentile": 26834.21, "90th_percentile": 26834.21, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5960.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11164.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6167.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4653.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6167.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11164.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5960.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6167.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5960.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7487.11 } ] } ] }, { "description": "HC CT ANGIO,UPPER EXTREM,COMBO", "code_information": [ { "code": "73206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2101.25, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1939.2997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1939.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CRYPTOCOCCUS NEOFORMANS AG, EIA", "code_information": [ { "code": "87327", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 808.44, "discounted_cash": 13.0, "minimum": 13.0416, "maximum": 704.9597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4171) INTERFLY, 1 MG", "code_information": [ { "code": "Q4171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 26.0795, "maximum": 26.0795, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.08 } ] } ] }, { "description": "HC X-RAY AC JTS", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 594.69, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 518.5697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 348.86, "10th_percentile": 348.86, "90th_percentile": 348.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 414.85, "10th_percentile": 414.85, "90th_percentile": 414.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4620) VARIABLE CONCENTRATION MASK", "code_information": [ { "code": "A4620", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.4544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC", "code_information": [ { "code": "406", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23105.0, "minimum": 19437.86, "maximum": 106391.5969, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22212.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 52406.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22212.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22212.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 60620.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23105.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19437.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23105.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60620.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22212.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 23105.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22212.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32255.1 } ] } ] }, { "description": "Meperidine HCl Inj 25 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641605201", "type": "NDC" }, { "code": "J2175", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 21.801, "maximum": 21.801, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.8 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19228.0, "minimum": 15744.64, "maximum": 53119.7606, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18493.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 43195.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18493.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18493.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44067.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19228.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15744.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19228.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44067.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18493.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19228.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18493.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26586.38 } ] } ] }, { "description": "HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD", "code_information": [ { "code": "81340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1025.0, "discounted_cash": 208.0, "minimum": 203.0285, "maximum": 1025.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 253.78, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 203.03, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 353.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prednisone Tab 10 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904692361", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Ondansetron Orally Disintegrating Tab 4 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68462015740", "type": "NDC" }, { "code": "Q0162", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL L2840) TIBIAL LENGTH SOCK FX OR EQU", "code_information": [ { "code": "L2840", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 50.0, "minimum": 48.9496, "maximum": 85.1857, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.18, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 48.95, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTHER, IV PUSH, SNGL DRUG", "code_information": [ { "code": "96409", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 523.44, "discounted_cash": 325.0, "minimum": 157.032, "maximum": 523.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 523.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 523.44, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 523.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 523.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC WHEELCHAIR MNGMENT TRAIN EA 15 MIN", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.44, "discounted_cash": 29.0, "minimum": 28.9208, "maximum": 98.9197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.15, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.92, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC", "code_information": [ { "code": "354", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13843.0, "minimum": 11773.87, "maximum": 41295.3595, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13325.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30400.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13325.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13325.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36773.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13843.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11773.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13843.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36773.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13325.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13843.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13325.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18711.11 } ] } ] }, { "description": "HC INJECT NERV BLCK,CELIAC PLEXUS", "code_information": [ { "code": "64530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3475.94, "discounted_cash": 872.0, "minimum": 872.7, "maximum": 3475.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3438.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3475.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3341.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ABLATE RENALTUMOR CRYO, UNILAT PERQ", "code_information": [ { "code": "50593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19218.8, "discounted_cash": 10488.0, "minimum": 5765.64, "maximum": 19218.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19218.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19218.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19218.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11432.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10488.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17738.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BIOPSY OF THYROID,PERCUT", "code_information": [ { "code": "60100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 607.5, "discounted_cash": 698.0, "minimum": 182.25, "maximum": 607.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 381.51, "10th_percentile": 381.51, "90th_percentile": 381.51, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 607.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED PROCEDURE ABDOMEN PERITONEUM & OMENTUM", "code_information": [ { "code": "49999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4783.13, "discounted_cash": 894.0, "minimum": 894.92, "maximum": 4282.8186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3525.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4282.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3426.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "754", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15054.0, "minimum": 12522.76, "maximum": 51834.2001, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14488.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33279.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14488.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14488.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33497.92 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15054.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12522.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15054.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33497.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14488.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15054.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14488.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20482.8 } ] } ] }, { "description": "HC (SUP SHELL L3933) FO W/O JOINTS CF", "code_information": [ { "code": "L3933", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 232.0, "minimum": 226.3225, "maximum": 393.8636, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 232.89, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 282.89, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 226.32, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 232.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 232.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 253.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 232.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 232.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 393.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6022) COLLAGEN DRSG>16<=48 SQ IN - A6022 - 27200110", "code_information": [ { "code": "A6022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 29.0, "minimum": 29.1248, "maximum": 50.6853, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.4, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [ { "code": "189", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10443.0, "minimum": 8564.45, "maximum": 28113.9466, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25309.0, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 71397.76, "10th_percentile": 71397.76, "90th_percentile": 71397.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10063.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22323.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10063.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10063.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14702.22 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10443.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8564.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10443.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14702.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10063.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10443.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10063.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13739.72 } ] } ] }, { "description": "HC (SUP SHELL L2186) ADJ MOTION KNEE JNT LERMAN T", "code_information": [ { "code": "L2186", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 177.0, "minimum": 172.8541, "maximum": 300.8137, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 177.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 193.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 177.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 177.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 177.87, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 172.85, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 177.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4160) NUSHIELD 1 SQ CM", "code_information": [ { "code": "Q4160", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VITAMIN B-12", "code_information": [ { "code": "82607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 271.88, "discounted_cash": 15.0, "minimum": 14.6547, "maximum": 237.0794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 174.0, "10th_percentile": 146.16, "90th_percentile": 174.0, "count": "50" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.32, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 138.55, "10th_percentile": 138.55, "90th_percentile": 180.12, "count": "24" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 146.31, "10th_percentile": 146.31, "90th_percentile": 149.12, "count": "79" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 67.41, "10th_percentile": 67.41, "90th_percentile": 174.0, "count": "18" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 79.13, "10th_percentile": 79.13, "90th_percentile": 79.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3982) UPPER EXT FX ORTHOSIS RAD/UL", "code_information": [ { "code": "L3982", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 488.0, "minimum": 474.7535, "maximum": 826.2019, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 488.53, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 593.42, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 474.75, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 488.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 488.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 488.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 488.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 826.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [ { "code": "957", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 59000.0, "minimum": 51662.19, "maximum": 165138.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 56656.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 137690.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 56656.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 56656.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 165137.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 59000.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51662.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 59000.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 165138.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 56656.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 59000.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 56656.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84746.09 } ] } ] }, { "description": "HC ANGIO AORTOBIFEMORAL W CATH", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10255.9, "discounted_cash": 3115.0, "minimum": 567.4444, "maximum": 10255.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10255.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10255.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10255.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 567.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRUG SCREEN QUANT ZONISAMIDE", "code_information": [ { "code": "80203", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.38, "discounted_cash": 13.0, "minimum": 12.8764, "maximum": 186.9394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L4392) REPLACE AFO SOFT INTERFACE", "code_information": [ { "code": "L4392", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 29.0, "minimum": 28.6487, "maximum": 49.8566, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.65, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT SHLDR DISLOC W MANIP W ANES", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1155.63, "discounted_cash": 1586.0, "minimum": 346.689, "maximum": 1155.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1155.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY SNGL ORGANIC ACID, QUANTITATIVE", "code_information": [ { "code": "83921", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 556.56, "discounted_cash": 21.0, "minimum": 20.6119, "maximum": 485.3203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 299.21, "10th_percentile": 299.21, "90th_percentile": 299.21, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 283.62, "10th_percentile": 283.62, "90th_percentile": 283.62, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 305.26, "10th_percentile": 299.52, "90th_percentile": 305.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 94.81, "10th_percentile": 94.81, "90th_percentile": 94.81, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 111.29, "10th_percentile": 110.93, "90th_percentile": 391.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.87, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOPATH CERV/VAG THIN LAYER", "code_information": [ { "code": "88142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.19, "discounted_cash": 20.0, "minimum": 19.6887, "maximum": 158.8697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 116.6, "10th_percentile": 97.94, "90th_percentile": 116.6, "count": "31" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 92.84, "10th_percentile": 92.84, "90th_percentile": 92.84, "count": "46" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 99.93, "10th_percentile": 98.05, "90th_percentile": 99.93, "count": "92" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 90.56, "10th_percentile": 90.56, "90th_percentile": 90.56, "count": "11" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 105.96, "10th_percentile": 105.96, "90th_percentile": 128.26, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC GENOTYPE DNA HIV REVERSE TRANSCRIPTASE", "code_information": [ { "code": "87901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1551.25, "discounted_cash": 257.0, "minimum": 250.1899, "maximum": 1352.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 312.72, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 250.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1350.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 435.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PRQ DRUG ELUTING COR REVASC T CABG S - 92937 - 48100196", "code_information": [ { "code": "92937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27935.9, "discounted_cash": 11390.0, "minimum": 8380.77, "maximum": 27935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EVAL OF BRONCHOSPASM", "code_information": [ { "code": "94060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 576.88, "discounted_cash": 368.0, "minimum": 173.064, "maximum": 576.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 351.6, "10th_percentile": 351.6, "90th_percentile": 351.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 576.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 576.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 576.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 337.98, "10th_percentile": 337.98, "90th_percentile": 352.12, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 351.99, "10th_percentile": 341.67, "90th_percentile": 351.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 336.92, "10th_percentile": 336.92, "90th_percentile": 353.79, "count": "11" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 348.08, "10th_percentile": 348.08, "90th_percentile": 348.08, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 401.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 386.76, "10th_percentile": 336.92, "90th_percentile": 402.43, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 576.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "828", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14006.0, "minimum": 11094.2, "maximum": 34892.0249, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13481.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30787.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13481.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13481.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30663.08 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14006.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11094.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14006.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30663.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13481.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14006.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13481.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18949.12 } ] } ] }, { "description": "HC MYCOPLASMA", "code_information": [ { "code": "86738", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.75, "discounted_cash": 13.0, "minimum": 12.8666, "maximum": 264.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ZINC", "code_information": [ { "code": "84630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.75, "discounted_cash": 11.0, "minimum": 11.0688, "maximum": 99.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 61.15, "10th_percentile": 61.15, "90th_percentile": 61.15, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.07, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 62.39, "10th_percentile": 61.22, "90th_percentile": 199.17, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 50.91, "10th_percentile": 50.91, "90th_percentile": 50.91, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 79.35, "10th_percentile": 79.35, "90th_percentile": 80.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF BARBITURATES - G0480 - 30100326", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.75, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4334) URINARY CATH LEG STRAP - A4334 - 27100023", "code_information": [ { "code": "A4334", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 6.8123, "maximum": 11.8553, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Sulfamethoxazole-Trimethoprim IV Soln 400-80 MG/5ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00703950301", "type": "NDC" }, { "code": "J2865", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC EXCISION THROMBOSED HEMORRHOID, EXTERNAL", "code_information": [ { "code": "46320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 480.0, "discounted_cash": 1180.0, "minimum": 144.0, "maximum": 480.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 480.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "624", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10569.0, "minimum": 6892.95, "maximum": 27074.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22621.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27074.22 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10569.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6892.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10569.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27074.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10569.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10184.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13923.23 } ] } ] }, { "description": "Cyclosporine Modified Cap 25 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "23155083711", "type": "NDC" }, { "code": "J7515", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.591, "maximum": 1.591, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.59 } ] } ] }, { "description": "Ampicillin Sodium For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55150011310", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.29, "maximum": 1.29, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.29 } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15719.0, "minimum": 13739.53, "maximum": 56663.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15126.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34858.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15126.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15126.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56663.77 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15719.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13739.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15719.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56663.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15126.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15719.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15126.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21454.83 } ] } ] }, { "description": "HC (SUP SHELL C1897) LEAD, NEUROSTIM TEST KIT", "code_information": [ { "code": "C1897", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1399.71, "10th_percentile": 1399.71, "90th_percentile": 1399.71, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1512.3, "10th_percentile": 1512.3, "90th_percentile": 1512.3, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6446) CONFORM BAND S W>=3 <5/YD - A6446 - 27200157", "code_information": [ { "code": "A6446", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "502", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11284.0, "minimum": 9670.48, "maximum": 39559.3002, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10870.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24320.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10870.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 34709.66, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 48897.8, "10th_percentile": 48897.8, "90th_percentile": 48897.8, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10870.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27748.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9670.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27748.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10870.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11284.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10870.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14968.67 } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "722", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14811.0, "minimum": 11966.29, "maximum": 39138.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14254.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32700.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14254.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14254.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39138.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14811.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11966.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14811.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39138.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14254.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14811.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14254.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20126.9 } ] } ] }, { "description": "HC CONTROL NOSE BLEED ANTER SIMPLE", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 454.38, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 454.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 454.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 454.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 454.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4175) MIRODERM", "code_information": [ { "code": "Q4175", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MYCOPHENOLATE ASSAY", "code_information": [ { "code": "80180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232.5, "discounted_cash": 18.0, "minimum": 17.541, "maximum": 202.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF", "code_information": [ { "code": "35876", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16595.6, "discounted_cash": 5490.0, "minimum": 4978.68, "maximum": 16595.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16595.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16595.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16595.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT", "code_information": [ { "code": "77002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1797.19, "minimum": 539.157, "maximum": 1567.1497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 345.49, "10th_percentile": 345.49, "90th_percentile": 386.92, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 786.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1253.72, "10th_percentile": 1253.72, "90th_percentile": 1253.72, "count": "1 through 10" } ] } ] }, { "description": "HC INJECTION RX EXTREMITY PSEUDOANEURYSM", "code_information": [ { "code": "36002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1255.31, "discounted_cash": 618.0, "minimum": 376.593, "maximum": 1255.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1255.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1255.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1255.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "566", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6746.0, "minimum": 5177.85, "maximum": 16148.943, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6516.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13539.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6516.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6516.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13151.34 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6746.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5177.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6746.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13151.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6516.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6746.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6516.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8333.47 } ] } ] }, { "description": "HC (SUP SHELL L0464) TLSO 4MOD SACRO-SCAP PRE", "code_information": [ { "code": "L0464", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1782.0, "minimum": 1732.6902, "maximum": 3015.3589, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1782.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1782.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2165.77, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1782.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1732.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1782.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1782.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1782.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1943.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1782.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1782.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1782.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1782.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1782.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3015.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC", "code_information": [ { "code": "656", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25262.0, "minimum": 22549.69, "maximum": 86185.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24282.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57530.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24282.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24282.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 86185.12 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25262.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22549.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25262.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 86185.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24282.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25262.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24282.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35409.2 } ] } ] }, { "description": "HC ASP/DRAIN LARGE JOINT/BURSA", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.38, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1179.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1297.77, "10th_percentile": 1297.77, "90th_percentile": 1297.77, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1179.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1159.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1889.09, "10th_percentile": 1889.09, "90th_percentile": 1889.09, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 582.71, "10th_percentile": 582.71, "90th_percentile": 582.71, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12971.0, "minimum": 10554.34, "maximum": 33903.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28328.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33903.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12971.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10554.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12971.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33903.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12971.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17435.46 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65160.0, "minimum": 58650.66, "maximum": 218088.8219, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 62567.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 152326.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 62567.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 191352.93, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 127468.42, "10th_percentile": 127468.42, "90th_percentile": 127468.42, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 62567.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 182310.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65160.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58650.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65160.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 182311.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 62567.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 65160.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 62567.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 93754.65 } ] } ] }, { "description": "HC APPL MULTLAY COMPRS ARM/HAND", "code_information": [ { "code": "29584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 602.5, "discounted_cash": 160.0, "minimum": 160.33, "maximum": 602.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 602.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 602.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 602.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9895.0, "minimum": 7290.71, "maximum": 21020.6449, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9537.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21020.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9537.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9537.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 7290.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9895.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8050.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9895.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7290.71 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9537.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9895.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9537.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12937.85 } ] } ] }, { "description": "HC REMOVE BILE CATH, PERQ W IMG", "code_information": [ { "code": "47537", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3467.5, "discounted_cash": 894.0, "minimum": 894.92, "maximum": 3467.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3467.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3467.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3426.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSIVE ENCEPHALOPATHY WITH CC", "code_information": [ { "code": "078", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6906.8, "maximum": 6906.8, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6906.8 } ] } ] }, { "description": "Lactated Ringer's Solution", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338011704", "type": "NDC" }, { "code": "J7120", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.945, "maximum": 4.945, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.95 } ] } ] }, { "description": "HC TCAT RMVL PERM LDLS PM RT VENT", "code_information": [ { "code": "33275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15294.7, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 14909.8005, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12273.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14909.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HPYLORI STOOL EIA", "code_information": [ { "code": "87338", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 506.25, "discounted_cash": 14.0, "minimum": 13.9745, "maximum": 441.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 305.6, "10th_percentile": 305.6, "90th_percentile": 305.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.97, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 64.28, "10th_percentile": 64.28, "90th_percentile": 64.28, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6209) FOAM DRSG <=16 SQ IN W/O BDR", "code_information": [ { "code": "A6209", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 10.3497, "maximum": 18.0113, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT BIG TOE FX WO MANIP", "code_information": [ { "code": "28490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 417.81, "discounted_cash": 243.0, "minimum": 125.343, "maximum": 417.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 417.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 417.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 417.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICROBE SUSCEPT MACROBROTH", "code_information": [ { "code": "87188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.81, "discounted_cash": 6.0, "minimum": 6.4528, "maximum": 54.7703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BX BREAST, NEEDLE CORE", "code_information": [ { "code": "19100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2550.31, "discounted_cash": 1629.0, "minimum": 765.093, "maximum": 2550.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2550.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2550.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2550.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2550.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ORAL FUNCTION THERAPY, 15 MIN", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 435.31, "discounted_cash": 80.0, "minimum": 78.6381, "maximum": 379.5903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.92, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.29, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 78.64, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 80.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 80.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 80.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 136.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ETHANOL - G0480 - 30100052", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1165.0, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT NEEDLE,INTRAOSSEOUS INFUSN", "code_information": [ { "code": "36680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 752.19, "discounted_cash": 440.0, "minimum": 225.657, "maximum": 752.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 752.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 752.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 752.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 745.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5821.0, "minimum": 4056.59, "maximum": 49965.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5628.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11342.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5628.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5628.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 49965.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5821.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4056.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5821.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49965.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5628.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5821.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5628.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6981.08 } ] } ] }, { "description": "HC UNLISTED PROCEDURE PELVIS/HIP JOINT", "code_information": [ { "code": "27299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3258.75, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 2841.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BACTERIA CULTURE SCREEN", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.31, "discounted_cash": 6.0, "minimum": 6.443, "maximum": 135.4303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 93.8, "10th_percentile": 67.4, "90th_percentile": 93.8, "count": "22" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 56.85, "10th_percentile": 53.67, "90th_percentile": 158.3, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 60.04, "10th_percentile": 60.04, "90th_percentile": 83.58, "count": "16" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 29.64, "10th_percentile": 29.64, "90th_percentile": 93.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 77.83, "10th_percentile": 34.79, "90th_percentile": 108.35, "count": "40" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MASTECTOMY FOR MALIGNANCY WITH CCMCC", "code_information": [ { "code": "582", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15700.0, "minimum": 12120.63, "maximum": 58958.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15107.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34813.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15107.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15107.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 58958.91 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15700.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12120.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15700.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58958.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15107.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15700.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15107.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21427.03 } ] } ] }, { "description": "HC CONVERT GASTROSTOMY GJ TUBE PERQ", "code_information": [ { "code": "49446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3443.44, "discounted_cash": 1893.0, "minimum": 1033.032, "maximum": 3443.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3443.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3443.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3443.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2063.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3202.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33697.0, "minimum": 31040.09, "maximum": 211394.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32376.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 77572.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 32376.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 32376.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 211393.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31040.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 211394.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32376.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 33697.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32376.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47744.26 } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC", "code_information": [ { "code": "420", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26960.0, "minimum": 24428.83, "maximum": 61565.7519, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 61565.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56593.62 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 26960.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24428.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26960.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56593.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 26960.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37892.68 } ] } ] }, { "description": "HC CT ANGIOGRAPHY CORO/HEART 3D", "code_information": [ { "code": "75574", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1814.06, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1814.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1106.87, "10th_percentile": 1064.26, "90th_percentile": 1106.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1814.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1204.72, "10th_percentile": 1204.72, "90th_percentile": 1204.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "833", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5024.0, "minimum": 3597.71, "maximum": 9448.7193, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4864.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 9448.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 4864.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 5670.54, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8706.33, "10th_percentile": 8706.33, "90th_percentile": 8706.33, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 4864.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 5932.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5024.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3597.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5024.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5932.71 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4864.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5024.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 4864.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5815.53 } ] } ] }, { "description": "HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR", "code_information": [ { "code": "96112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 434.38, "discounted_cash": 126.0, "minimum": 95.0, "maximum": 434.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 434.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 434.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 434.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAINAGE OF MOUTH LESION, SIMPLE", "code_information": [ { "code": "40800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.69, "discounted_cash": 698.0, "minimum": 125.907, "maximum": 419.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4628) OROPHARYNGEAL SUCTION CATH - A4628 - RU272036", "code_information": [ { "code": "A4628", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 5.1797, "maximum": 9.0141, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 163426.0, "minimum": 139203.87, "maximum": 461741.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 156858.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 385800.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 156858.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 156858.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 461740.63 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 163426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 139203.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 163426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 461741.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 156858.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 163426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 156858.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 237453.43 } ] } ] }, { "description": "HC SUBQ INFUSION, THERAP/PROPH/DIAGNOST INIT 1ST HR", "code_information": [ { "code": "96369", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 755.94, "discounted_cash": 209.0, "minimum": 209.87, "maximum": 755.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 755.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 755.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 755.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 354.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT PROX HUMERUS FX WO MANIP", "code_information": [ { "code": "23600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 842.5, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 842.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 842.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 842.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 842.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COLLECTION VENOUS BLOOD,VENIPUNCTURE", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 9.0, "minimum": 9.0766, "maximum": 34.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.6, "10th_percentile": 21.5, "90th_percentile": 25.6, "count": "342" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 11.04, "10th_percentile": 11.04, "90th_percentile": 11.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 20.38, "10th_percentile": 6.09, "90th_percentile": 27.91, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 27.91, "10th_percentile": 27.9, "90th_percentile": 28.16, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 25.12, "10th_percentile": 25.12, "90th_percentile": 25.6, "count": "166" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 27.9, "10th_percentile": 27.9, "90th_percentile": 28.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NONTRAUMATIC STUPOR AND COMA WITHOUT MCC", "code_information": [ { "code": "081", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7859.0, "minimum": 6262.42, "maximum": 23296.4697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7583.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16183.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7583.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 20440.51, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22084.31, "10th_percentile": 22084.31, "90th_percentile": 22084.31, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7583.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16424.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7859.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6262.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7859.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16424.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7583.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7859.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7583.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9960.58 } ] } ] }, { "description": "HC VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ", "code_information": [ { "code": "61026", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1102.19, "discounted_cash": 696.0, "minimum": 330.657, "maximum": 1102.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1102.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1102.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1102.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1102.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA", "code_information": [ { "code": "37607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12271.6, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 12271.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12271.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12271.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6220) GAUZE >16 <=48 SQ IN W/BORDR - A6220 - RU272047", "code_information": [ { "code": "A6220", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.5859, "maximum": 6.2405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.59, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4014) CAST SUP GAUNTLET FIBERGLASS", "code_information": [ { "code": "Q4014", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 33.0, "minimum": 32.8857, "maximum": 57.2302, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.11, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.89, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.89, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "166", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29474.0, "minimum": 26649.2, "maximum": 78756.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28324.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 67539.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28324.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28324.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 78756.07 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 29474.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26649.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29474.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78756.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28324.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 29474.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28324.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41569.5 } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6764.0, "minimum": 5173.69, "maximum": 28492.9493, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6533.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13581.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6533.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6533.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15167.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6764.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5173.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6764.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15167.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6533.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6764.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6533.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8359.05 } ] } ] }, { "description": "HC ASSAY OTHER FLUID CHLORIDES", "code_information": [ { "code": "82438", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.06, "discounted_cash": 5.0, "minimum": 4.859, "maximum": 82.0203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3 - 80339 - 30100444", "code_information": [ { "code": "80339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 874.38, "minimum": 26.236, "maximum": 762.4594, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.24 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 580.8, "10th_percentile": 580.8, "90th_percentile": 580.8, "count": "1 through 10" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7361.0, "minimum": 5776.54, "maximum": 20416.0555, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7105.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14999.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7105.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7105.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12167.42 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7361.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5776.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7361.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12167.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7105.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7361.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7105.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9232.11 } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITH MCC", "code_information": [ { "code": "901", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32964.0, "minimum": 30664.95, "maximum": 90757.9, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 90757.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31673.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 32964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31673.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46673.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31673.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75831.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31673.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31673.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 90757.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30664.95 } ] } ] }, { "description": "HC (SUP SHELL A7041) WATER SEAL DRAIN CONTAINER", "code_information": [ { "code": "A7041", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 105.0, "minimum": 102.7484, "maximum": 178.8106, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.43, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.75, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 178.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Morphine Sulfate IV Soln PF 4 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641612501", "type": "NDC" }, { "code": "J2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.9545, "maximum": 9.9545, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 47.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 14.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "Magnesium Sulfate IV Soln 2 GM/50ML (40 MG/ML)", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338170840", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0535, "maximum": 1.0535, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 72.46, "10th_percentile": 72.46, "90th_percentile": 144.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 80.49, "10th_percentile": 80.49, "90th_percentile": 80.49, "count": "1 through 10" } ] } ] }, { "description": "HC INTUBATION ENDOTRACHEAL", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 838.44, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 838.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 531.23, "10th_percentile": 531.23, "90th_percentile": 531.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 838.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 838.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 838.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT", "code_information": [ { "code": "54235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 912.19, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 912.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ", "code_information": [ { "code": "76885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 449.38, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 449.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 449.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAINAGE OF URETHRA ABSCESS", "code_information": [ { "code": "53060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9449.06, "discounted_cash": 2062.0, "minimum": 2062.58, "maximum": 9449.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8125.74, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9449.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7897.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD BODY/SCALP/EXTR 2.6-7.5 CM", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1836.25, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 1836.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4559) COUPLING GEL OR PASTE", "code_information": [ { "code": "A4559", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CADMIUM", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.25, "discounted_cash": 23.0, "minimum": 22.875, "maximum": 76.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.72, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVE FB MUSC/TENDON, SIMPLE", "code_information": [ { "code": "20520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 743.75, "discounted_cash": 1629.0, "minimum": 223.125, "maximum": 743.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8658) INTERPHALANGEAL JOINT SPACER", "code_information": [ { "code": "L8658", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 498.0, "minimum": 484.141, "maximum": 842.5389, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 498.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 498.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 498.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 498.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 498.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 842.54, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 498.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.19, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.15, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 498.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.14, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 498.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 498.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 498.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 543.03, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY MASTOIDS 3+ VW", "code_information": [ { "code": "70130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 508.75, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 403.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Estrogens, Conjugated For Inj 25 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00046074905", "type": "NDC" }, { "code": "J1410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 391.0, "minimum": 381.0039, "maximum": 1543.2122, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 391.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1543.21, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 391.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 381.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 823.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 391.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 391.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 391.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 426.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 391.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 391.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 391.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 391.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 391.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 662.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LIGATION MAJOR ARTERY EXTREMITY", "code_information": [ { "code": "37618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7910.63, "minimum": 2373.189, "maximum": 6898.0694, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2944.01 } ] } ] }, { "description": "Fentanyl Citrate-NaCl 0.9% IV Soln 1 MG/100ML (10 MCG/ML)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "71266505001", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.806, "maximum": 1.806, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 28.54, "count": "52" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.81 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 4.45, "90th_percentile": 29.69, "count": "19" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42593.0, "minimum": 36822.86, "maximum": 123946.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40913.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 98710.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 40913.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 40913.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 123946.02 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 42593.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36822.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42593.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 123946.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40913.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 42593.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40913.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 60754.4 } ] } ] }, { "description": "HC GLUCOSE TEST", "code_information": [ { "code": "82950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.31, "discounted_cash": 4.0, "minimum": 4.6161, "maximum": 74.3903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 45.6, "10th_percentile": 38.3, "90th_percentile": 54.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.62, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 36.31, "10th_percentile": 36.31, "90th_percentile": 36.31, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 38.34, "10th_percentile": 38.34, "90th_percentile": 38.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.23, "10th_percentile": 14.25, "90th_percentile": 21.23, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 49.7, "10th_percentile": 24.92, "90th_percentile": 50.16, "count": "37" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TANGENTIAL BIOPSY SKIN SINGLE LESION", "code_information": [ { "code": "11102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1149.38, "discounted_cash": 401.0, "minimum": 344.814, "maximum": 1149.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1149.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1149.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1149.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4398) OSTOMY IRRIGATION BAG", "code_information": [ { "code": "A4398", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 19.0, "minimum": 18.8043, "maximum": 32.7247, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2 - G0480 - 31080332", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.06, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44629.0, "minimum": 39486.88, "maximum": 133242.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42866.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 103545.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 42866.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 42866.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 133241.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 44629.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39486.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44629.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 133242.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42866.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 44629.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42866.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63730.56 } ] } ] }, { "description": "Testosterone Cypionate IM Inj in Oil 200 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00143965901", "type": "NDC" }, { "code": "J1071", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC X-RAY LUMBAR SPINE 6+ VW", "code_information": [ { "code": "72114", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 984.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 858.1003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 412.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 102.92, "10th_percentile": 102.92, "90th_percentile": 102.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TOTAL CORTISOL", "code_information": [ { "code": "82533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.44, "discounted_cash": 16.0, "minimum": 15.8403, "maximum": 194.8397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 143.0, "10th_percentile": 143.0, "90th_percentile": 143.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 113.86, "10th_percentile": 113.86, "90th_percentile": 113.86, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 122.55, "10th_percentile": 120.25, "90th_percentile": 127.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 72.86, "10th_percentile": 72.86, "90th_percentile": 72.86, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 155.87, "10th_percentile": 85.53, "90th_percentile": 157.3, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.57, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OBSTETRIC PANEL", "code_information": [ { "code": "80055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 329.38, "discounted_cash": 47.0, "minimum": 46.4618, "maximum": 287.2194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 198.8, "10th_percentile": 198.8, "90th_percentile": 198.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.46, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 47.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 213.71, "10th_percentile": 53.74, "90th_percentile": 213.71, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 47.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 47.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3670) SHOULDER ORTHOS ACROMIO/CLAV PREFAB", "code_information": [ { "code": "L3670", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 127.0, "minimum": 123.5644, "maximum": 215.0361, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 154.45, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 123.56, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 215.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY TEST FOR BLOOD FECAL", "code_information": [ { "code": "82274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.25, "discounted_cash": 15.0, "minimum": 15.4711, "maximum": 101.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 74.4, "10th_percentile": 74.4, "90th_percentile": 74.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 59.24, "10th_percentile": 59.24, "90th_percentile": 59.24, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 62.56, "10th_percentile": 62.56, "90th_percentile": 63.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 71.16, "10th_percentile": 71.16, "90th_percentile": 74.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 81.1, "10th_percentile": 81.1, "90th_percentile": 83.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4344) CATH INDW FOLEY 2 WAY SILICN - A4344 - RU278116", "code_information": [ { "code": "A4344", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 22.0, "minimum": 22.1668, "maximum": 38.5763, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.71, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.86, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4", "code_information": [ { "code": "11056", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 441.25, "discounted_cash": 197.0, "minimum": 132.375, "maximum": 441.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LD SYS", "code_information": [ { "code": "33228", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35935.9, "discounted_cash": 10313.0, "minimum": 10313.01, "maximum": 35935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11241.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17441.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16426.0, "minimum": 12165.62, "maximum": 43730.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15804.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36539.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15804.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15804.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43730.64 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16426.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12165.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16426.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43730.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15804.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16426.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15804.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22489.15 } ] } ] }, { "description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC", "code_information": [ { "code": "863", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8637.0, "minimum": 6920.64, "maximum": 26838.1363, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8330.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18031.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8330.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8330.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13987.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8637.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6920.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8637.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13987.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 26838.14, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9028.52, "10th_percentile": 9028.52, "90th_percentile": 9028.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8330.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8637.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8330.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11098.32 } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITH MCC", "code_information": [ { "code": "385", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13082.0, "minimum": 11245.78, "maximum": 32586.0715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12595.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28591.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12595.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12595.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24258.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13082.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11245.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13082.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24258.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12595.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13082.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12595.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17597.83 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39380.0, "minimum": 31786.9, "maximum": 98666.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37830.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 91075.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 37830.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 84859.21, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 48904.63, "10th_percentile": 48904.63, "90th_percentile": 48904.63, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37830.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 98666.22 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 39380.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31786.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39380.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 98666.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37830.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 39380.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37830.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56055.49 } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS", "code_information": [ { "code": "208", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21952.0, "minimum": 18575.47, "maximum": 65539.7306, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 49668.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40295.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21952.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18575.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21952.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40295.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21952.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21107.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30570.16 } ] } ] }, { "description": "HC ASSAY OF CRYOGLOBULIN", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.63, "discounted_cash": 6.0, "minimum": 6.2875, "maximum": 30.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 24.5, "10th_percentile": 24.5, "90th_percentile": 24.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 21.36, "10th_percentile": 21.36, "90th_percentile": 21.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEP C ANTIBODY, HIGH RISK - G0472 - 30200256", "code_information": [ { "code": "G0472", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.06, "discounted_cash": 46.0, "minimum": 45.0429, "maximum": 243.2077, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.35, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.3, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.04, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 243.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4161) BIO-CONNEKT PER SQUARE CM", "code_information": [ { "code": "Q4161", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 3985.369, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3985.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6402) STERILE GAUZE <= 16 SQ IN - A6402 - RU272059", "code_information": [ { "code": "A6402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US, ABDOMEN LIMITED", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.88, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 585.8794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 615.8, "10th_percentile": 615.8, "90th_percentile": 615.8, "count": "14" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 488.02, "10th_percentile": 488.02, "90th_percentile": 488.02, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 622.36, "10th_percentile": 598.4, "90th_percentile": 622.36, "count": "17" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 523.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 233.29, "10th_percentile": 86.64, "90th_percentile": 615.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 677.38, "10th_percentile": 590.09, "90th_percentile": 711.55, "count": "45" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT NOSE XF WO STABIL", "code_information": [ { "code": "21315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2236.88, "discounted_cash": 1530.0, "minimum": 671.064, "maximum": 2236.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INCISIONAL BIOPSY SKIN SINGLE LESION", "code_information": [ { "code": "11106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2244.06, "discounted_cash": 729.0, "minimum": 673.218, "maximum": 2244.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2244.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2244.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2244.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3917) METACARP FX ORTHOSIS PRE CST", "code_information": [ { "code": "L3917", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 115.0, "minimum": 112.1166, "maximum": 195.1137, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 115.37, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.14, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 112.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 115.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 115.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 115.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 115.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 195.11, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 MG/ML - 67457042300", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "67457042300", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "40" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 4.45, "90th_percentile": 14.84, "count": "24" } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj PF 1000 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009001820", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 43.31, "10th_percentile": 43.31, "90th_percentile": 159.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 51.04, "10th_percentile": 51.04, "90th_percentile": 53.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "count": "1 through 10" } ] } ] }, { "description": "HC SURG PATH,LEVEL III", "code_information": [ { "code": "88304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 371.25, "discounted_cash": 51.0, "minimum": 51.42, "maximum": 323.73, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.08, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 125.03, "10th_percentile": 56.62, "90th_percentile": 250.05, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 199.58, "10th_percentile": 199.58, "90th_percentile": 237.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC JAK2 TARGETED SEQUENCE ANALYSIS", "code_information": [ { "code": "81279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 800.94, "discounted_cash": 185.0, "minimum": 179.9774, "maximum": 800.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 224.96, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 179.98, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 313.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT NECK TISSUE CONTRAST", "code_information": [ { "code": "70491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2634.06, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2296.9003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1335.94, "10th_percentile": 1335.94, "90th_percentile": 1335.94, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1545.47, "10th_percentile": 1545.47, "90th_percentile": 1545.47, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1091.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 482.4, "10th_percentile": 482.4, "90th_percentile": 482.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1837.52, "10th_percentile": 1749.44, "90th_percentile": 1837.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "969", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47602.0, "minimum": 43772.57, "maximum": 132382.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45719.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 110610.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 45719.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45719.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 132382.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 47602.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43772.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47602.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 132382.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45719.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 47602.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45719.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68079.14 } ] } ] }, { "description": "HC CLSD TREAT TAR-METATAR DISLOC W ANES", "code_information": [ { "code": "28605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2052.81, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 1790.0503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1164.74, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FLOWCYTOMETRY/TC ADD-ON", "code_information": [ { "code": "88185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.31, "minimum": 81.093, "maximum": 235.7103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2154.18, "10th_percentile": 2064.42, "90th_percentile": 2423.46, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 1709.33, "10th_percentile": 1709.33, "90th_percentile": 1742.11, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.85 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2449.04, "10th_percentile": 2215.75, "90th_percentile": 3088.68, "count": "1 through 10" } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC", "code_information": [ { "code": "803", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15185.0, "minimum": 12319.97, "maximum": 44948.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33590.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44948.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15185.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12319.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15185.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44948.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15185.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20674.09 } ] } ] }, { "description": "MINOR SKIN DISORDERS WITH MCC", "code_information": [ { "code": "606", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12556.0, "minimum": 11145.42, "maximum": 27343.2819, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12091.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27343.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12091.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12091.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21616.91 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12556.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11145.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12556.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21616.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12091.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12556.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12091.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16829.33 } ] } ] }, { "description": "HC (SUP SHELL L8670) VASCULAR GRAFT, SYNTHETIC", "code_information": [ { "code": "L8670", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 681.0, "minimum": 662.272, "maximum": 1152.5359, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.49, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 827.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.27, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 681.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 681.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 742.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 681.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 681.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1152.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, FACE, NECK", "code_information": [ { "code": "70540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2005.94, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1749.1797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1488.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MR SAFETY IMPLANT&/FB ASSMT CLIN STAFF EA ADD 30", "code_information": [ { "code": "76015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.88, "minimum": 27.564, "maximum": 91.88, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.88 } ] } ] }, { "description": "HC CT SCAN ABDOMEN/PELVIS COMBO", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3903.13, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 3403.5294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 983.67, "10th_percentile": 983.67, "90th_percentile": 983.67, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2243.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 345.64, "10th_percentile": 345.64, "90th_percentile": 2085.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Adenosine IV Soln 6 MG/2ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "25021031802", "type": "NDC" }, { "code": "J0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC SUPRAPUBIC BLADDER ASPIRATION, NEEDLE", "code_information": [ { "code": "51100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1350.94, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1179.8186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT ACETABULAR FX W MANIP", "code_information": [ { "code": "27222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 799.38, "discounted_cash": 243.0, "minimum": 239.814, "maximum": 799.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 799.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 799.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 799.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THORACENTESIS NDL/CATH PLEURA ASP W IMAG", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2691.25, "discounted_cash": 618.0, "minimum": 618.95, "maximum": 2691.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2438.42, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2691.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2369.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC", "code_information": [ { "code": "657", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14965.0, "minimum": 12652.88, "maximum": 53861.4468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33067.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46701.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14965.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12652.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14965.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46701.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14965.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20352.67 } ] } ] }, { "description": "HC CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST", "code_information": [ { "code": "75557", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 978.13, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 978.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 978.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 978.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR CV CATH W/O SUBQ PORT OR PUMP", "code_information": [ { "code": "36575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1545.94, "discounted_cash": 618.0, "minimum": 463.782, "maximum": 1545.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 329.06, "discounted_cash": 302.0, "minimum": 98.718, "maximum": 329.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 329.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 329.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 329.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 823.28, "10th_percentile": 823.28, "90th_percentile": 823.28, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 329.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 329.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC GROUP TRAIN W/O PATIENT", "code_information": [ { "code": "G0543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.88, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 111.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.88, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.88, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ULTRASOUND ELASTOGRAPHY PARENCHYMA", "code_information": [ { "code": "76981", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 669.8111, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 669.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC", "code_information": [ { "code": "872", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8830.0, "minimum": 7135.89, "maximum": 26318.0192, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8515.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18490.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8515.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 23091.65, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 14309.96, "10th_percentile": 14309.96, "90th_percentile": 57787.83, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8515.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15068.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8830.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7135.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8830.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15068.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8515.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8830.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8515.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11380.82 } ] } ] }, { "description": "HC TRANSLUM PERIPHERL ATHERECTOMY BRACHIOCEPHAL EA", "code_information": [ { "code": "0237T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67082.2, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 58495.6784, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44874.72, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54512.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF LIDOCAINE", "code_information": [ { "code": "80176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.81, "discounted_cash": 14.0, "minimum": 14.2757, "maximum": 120.1703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF BLOOD LIPOPROTEIN,HDL CHOLEST", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.19, "discounted_cash": 8.0, "minimum": 7.959, "maximum": 154.5097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 36.61, "10th_percentile": 36.61, "90th_percentile": 36.61, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.96, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 95.36, "10th_percentile": 95.36, "90th_percentile": 95.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT PICC W/O SUB-Q PORT", "code_information": [ { "code": "36569", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6136.56, "discounted_cash": 1553.0, "minimum": 1553.22, "maximum": 6136.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6119.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6136.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5946.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4316) CATH W/DRAINAGE 3-WAY", "code_information": [ { "code": "A4316", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 40.0, "minimum": 39.3287, "maximum": 68.4429, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.47, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.16, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.33, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 40.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 40.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 40.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEST X-RAY 4 VW", "code_information": [ { "code": "71048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 610.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 531.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 274.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RBC SED RATE, NONAUTO", "code_information": [ { "code": "85651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.13, "discounted_cash": 4.0, "minimum": 4.1496, "maximum": 89.9294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 62.2, "10th_percentile": 52.25, "90th_percentile": 62.2, "count": "39" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 49.53, "10th_percentile": 49.53, "90th_percentile": 52.55, "count": "27" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 53.31, "10th_percentile": 53.31, "90th_percentile": 55.5, "count": "81" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 19.09, "10th_percentile": 19.09, "90th_percentile": 62.2, "count": "31" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 68.42, "10th_percentile": 68.42, "90th_percentile": 71.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RICKETTSIA", "code_information": [ { "code": "86757", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 477.19, "discounted_cash": 19.0, "minimum": 18.8043, "maximum": 416.1097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR EXTEN TENDON FINGER EA", "code_information": [ { "code": "26418", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2091.88, "discounted_cash": 1586.0, "minimum": 627.564, "maximum": 2091.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2091.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2091.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2091.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2091.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE CREATININE", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.63, "discounted_cash": 5.0, "minimum": 5.0339, "maximum": 87.7494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 64.4, "10th_percentile": 54.1, "90th_percentile": 64.4, "count": "30" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 51.28, "10th_percentile": 51.28, "90th_percentile": 51.28, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 55.19, "10th_percentile": 54.15, "90th_percentile": 55.19, "count": "48" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.15, "10th_percentile": 23.15, "90th_percentile": 23.15, "count": "22" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 70.84, "10th_percentile": 70.84, "90th_percentile": 70.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4369) SKIN BARRIER LIQUID PER OZ", "code_information": [ { "code": "A4369", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.3624, "maximum": 5.8516, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.36, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10693.0, "minimum": 8890.45, "maximum": 29381.1844, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10303.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22917.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10303.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10303.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19947.17 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10693.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8890.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19947.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10303.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10693.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10303.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14105.63 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC", "code_information": [ { "code": "206", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8205.0, "minimum": 6269.34, "maximum": 30213.5583, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7915.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17005.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7915.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7915.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12938.97 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8205.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6269.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8205.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12939.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7915.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8205.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7915.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10466.61 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC", "code_information": [ { "code": "357", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18734.0, "minimum": 15586.84, "maximum": 57232.8044, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18018.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 42021.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18018.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18018.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40847.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18734.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15586.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18734.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40847.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18018.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18734.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18018.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25863.47 } ] } ] }, { "description": "Isosulfan Blue Subcutaneous Soln 1%", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "67457022000", "type": "NDC" }, { "code": "Q9968", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 10.287, "maximum": 49.2305, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.53, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.23, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PROSTATECTOMY WITHOUT CCMCC", "code_information": [ { "code": "667", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9461.0, "minimum": 7113.74, "maximum": 23923.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9120.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19988.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9120.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9120.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23923.75 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9461.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7113.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9461.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23923.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9120.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9461.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9120.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12302.8 } ] } ] }, { "description": "HC IRRIG IMPLANTED DRUG DELIVERY DEVICE", "code_information": [ { "code": "96523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.44, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 360.5197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 232.85, "10th_percentile": 129.35, "90th_percentile": 242.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI JOINT UPPER EXTREM WO CONTRAST", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2668.44, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2326.8797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1434.55, "10th_percentile": 1293.43, "90th_percentile": 1434.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1272.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 565.19, "10th_percentile": 565.19, "90th_percentile": 565.19, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PENIS PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "710", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11704.0, "minimum": 10391.68, "maximum": 28954.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11273.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25319.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11273.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11273.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28954.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10391.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28954.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11273.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11273.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15583.7 } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "544", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6787.0, "minimum": 5230.45, "maximum": 13635.5013, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6554.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13635.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6554.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6554.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10949.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6787.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5230.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6787.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10949.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6554.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6787.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6554.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8392.42 } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CCMCC", "code_information": [ { "code": "244", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14794.0, "minimum": 12490.92, "maximum": 57143.9052, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14238.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32661.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14238.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14238.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39530.01 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14794.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12490.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14794.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39530.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14238.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14794.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14238.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20102.44 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC", "code_information": [ { "code": "083", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11663.0, "minimum": 9623.42, "maximum": 25930.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11234.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25221.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11234.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11234.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25930.55 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11663.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9623.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11663.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25930.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11234.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11663.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11234.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15523.64 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18716.0, "minimum": 17331.7, "maximum": 80495.5524, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43337.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18001.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18716.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18001.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25836.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 72464.46, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 109794.11, "10th_percentile": 109794.11, "90th_percentile": 109794.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18001.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 41978.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18001.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18001.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43337.07 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18716.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17331.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18716.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC RH IG, FULL-DOSE, IM - J2790 - 39000005", "code_information": [ { "code": "J2790", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 512.81, "minimum": 153.843, "maximum": 447.1703, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.89 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9820.0, "minimum": 6685.2793, "maximum": 27138.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 8944.85, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7580.39, "10th_percentile": 7580.39, "90th_percentile": 7580.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9465.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20841.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9465.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9465.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27138.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9820.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8012.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9820.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27138.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9465.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9820.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9465.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12827.75 } ] } ] }, { "description": "SKIN DEBRIDEMENT WITH MCC", "code_information": [ { "code": "570", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23416.0, "minimum": 20834.59, "maximum": 113910.6026, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22511.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 53145.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22511.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22511.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51192.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23416.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20834.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23416.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51192.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22511.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 23416.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22511.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32709.97 } ] } ] }, { "description": "HC POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND", "code_information": [ { "code": "95810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5919.69, "discounted_cash": 847.0, "minimum": 847.32, "maximum": 5161.9697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3338.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4055.02, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3244.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 923.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1432.99, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT CARPOMETACAR DISLOC,NON-THUMB W ANES", "code_information": [ { "code": "26670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 481.88, "discounted_cash": 243.0, "minimum": 144.564, "maximum": 481.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 481.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 481.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 481.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY INTRODUCTN GI TUBE", "code_information": [ { "code": "74340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 607.19, "minimum": 182.157, "maximum": 607.19, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 607.19 } ] } ] }, { "description": "HC VEN THROMBOSIS IMAGES, BILAT", "code_information": [ { "code": "78458", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1104.38, "discounted_cash": 394.0, "minimum": 331.314, "maximum": 1104.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1104.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4430) OST URINE PCH W B/BLTIN CONV", "code_information": [ { "code": "A4430", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 12.0, "minimum": 11.7977, "maximum": 20.5312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD NECK/HND/FT/GENT 12.5-20 CM", "code_information": [ { "code": "12045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2287.81, "discounted_cash": 729.0, "minimum": 686.343, "maximum": 2287.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2287.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2287.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2287.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LARYNGOSCOPY DIRECT ASPIRATION", "code_information": [ { "code": "31515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2440.63, "discounted_cash": 385.0, "minimum": 385.91, "maximum": 2128.2294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 385.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1520.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1846.85, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 385.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1477.53, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 385.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 385.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 385.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 420.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 385.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 385.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 385.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 385.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 385.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 652.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC", "code_information": [ { "code": "35301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12131.3, "minimum": 3639.39, "maximum": 12131.3, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12131.3 } ] } ] }, { "description": "HC CT ANGIO ABD & PLVIS WO/W CONTRAST", "code_information": [ { "code": "74174", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3140.0, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2738.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2527.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6891.0, "minimum": 5389.64, "maximum": 13883.0581, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6654.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13883.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6654.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6654.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10267.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6891.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5389.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6891.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10267.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6654.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6891.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6654.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8544.79 } ] } ] }, { "description": "HC DIGITAL BREAST TOMOSYNTHESIS UNILAT - 77061 - 40100010", "code_information": [ { "code": "77061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.88, "minimum": 150.564, "maximum": 501.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 321.2, "10th_percentile": 321.2, "90th_percentile": 321.2, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 254.55, "10th_percentile": 254.55, "90th_percentile": 254.55, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 306.22, "10th_percentile": 306.22, "90th_percentile": 312.13, "count": "20" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.88 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 317.99, "10th_percentile": 113.95, "90th_percentile": 317.99, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 350.11, "10th_percentile": 307.79, "90th_percentile": 353.32, "count": "11" } ] } ] }, { "description": "HC DEVELOPMENTAL SCREEN - 96110 - 44000053", "code_information": [ { "code": "96110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 449.06, "minimum": 95.0, "maximum": 391.5803, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC I&D OF VULVA/PERINEUM ABSCESS", "code_information": [ { "code": "56405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 447.19, "discounted_cash": 300.0, "minimum": 134.157, "maximum": 447.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 447.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 447.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 447.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 447.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC", "code_information": [ { "code": "495", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28622.0, "minimum": 24367.23, "maximum": 78411.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27507.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 65515.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27507.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27507.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 78411.21 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28622.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24367.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28622.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78411.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27507.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28622.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27507.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40323.88 } ] } ] }, { "description": "Morphine Sulfate Inj PF 1 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409381511", "type": "NDC" }, { "code": "J2274", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 21.113, "maximum": 21.113, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.11 } ] } ] }, { "description": "HC REFILL/MAINT PUMP/RESVR SYST", "code_information": [ { "code": "96522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.94, "discounted_cash": 209.0, "minimum": 81.282, "maximum": 270.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 270.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 270.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 270.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 270.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4367) OSTOMY BELT", "code_information": [ { "code": "A4367", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 10.1942, "maximum": 17.7407, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PARATHORMONE", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.13, "discounted_cash": 41.0, "minimum": 40.1159, "maximum": 294.8494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 216.4, "10th_percentile": 216.4, "90th_percentile": 216.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.14, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.12, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 172.31, "10th_percentile": 172.31, "90th_percentile": 172.31, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 181.97, "10th_percentile": 181.97, "90th_percentile": 185.45, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 184.52, "10th_percentile": 184.52, "90th_percentile": 216.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 238.04, "10th_percentile": 238.04, "90th_percentile": 238.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL V2628) FABRICATION & FITTING", "code_information": [ { "code": "V2628", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 372.0, "minimum": 361.9761, "maximum": 629.9382, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 372.48, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 452.45, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 361.98, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 372.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 372.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 406.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 372.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 372.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 372.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 629.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Amiodarone HCl in Dextrose 4.21% IV Soln 150 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "43066015010", "type": "NDC" }, { "code": "J0282", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CT SCAN,THORACIC SPINE,W/O CONTRAST", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2050.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1787.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 757.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [ { "code": "791", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31918.0, "minimum": 5998.96, "maximum": 73345.4806, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 34974.01, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 56320.2, "10th_percentile": 56320.2, "90th_percentile": 56320.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30669.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 73345.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 30669.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 30669.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 5998.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 31918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28099.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5998.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 38850.11, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 10295.85, "10th_percentile": 10295.85, "90th_percentile": 10295.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30669.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 31918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30669.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45142.9 } ] } ] }, { "description": "HC (SUP SHELL Q4151) AMNIOBAND, GUARDIAN 1 SQ CM", "code_information": [ { "code": "Q4151", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 293.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC", "code_information": [ { "code": "814", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17222.0, "minimum": 12044.42, "maximum": 38429.1287, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16568.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38429.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16568.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16568.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31728.83 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17222.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14469.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17222.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31728.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16568.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17222.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16568.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23652.48 } ] } ] }, { "description": "NERVOUS SYSTEM NEOPLASMS WITH MCC", "code_information": [ { "code": "054", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12660.0, "minimum": 10375.77, "maximum": 37188.1877, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12190.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12190.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16981.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12190.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27590.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12190.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12190.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34037.62 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10375.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12660.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34037.6 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13247.0, "minimum": 11360.67, "maximum": 38438.6762, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12754.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28985.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12754.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12754.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28769.29 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11360.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28769.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12754.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13247.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12754.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17840.29 } ] } ] }, { "description": "HC (SUP SHELL A6154) WOUND POUCH EACH", "code_information": [ { "code": "A6154", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 20.0, "minimum": 19.9122, "maximum": 34.6527, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [ { "code": "963", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21839.0, "minimum": 18803.18, "maximum": 64412.181, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20998.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 49399.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20998.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20998.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 55981.85 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18803.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55981.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20998.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21839.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20998.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30404.45 } ] } ] }, { "description": "Glucagon HCl (rDNA) For Inj 1 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00548585000", "type": "NDC" }, { "code": "J1610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 146.0, "minimum": 146.332, "maximum": 576.4895, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 576.49, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.62, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 177.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 410.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 146.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 146.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 146.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 146.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.48, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9753.0, "minimum": 7778.19, "maximum": 37784.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9401.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20684.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9401.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9401.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37784.29 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9753.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7778.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9753.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37784.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9401.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9753.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9401.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12730.99 } ] } ] }, { "description": "HC ASSAY OF TRANSCORTIN", "code_information": [ { "code": "84449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.38, "discounted_cash": 18.0, "minimum": 17.4924, "maximum": 230.5394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.49, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "352", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9929.0, "minimum": 7631.46, "maximum": 38491.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9570.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21101.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9570.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 29452.26, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 27871.48, "10th_percentile": 27871.48, "90th_percentile": 27871.48, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9570.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38491.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9929.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7631.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9929.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38491.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9570.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9929.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9570.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12987.9 } ] } ] }, { "description": "OSTEOMYELITIS WITH MCC", "code_information": [ { "code": "539", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16028.0, "minimum": 13997.7, "maximum": 35592.1638, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35592.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33084.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16028.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13997.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16028.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33084.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16028.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21906.37 } ] } ] }, { "description": "HC PERQ BREAST LOC DEV PLACE STROTACT GUID 1ST LES", "code_information": [ { "code": "19283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 713.44, "discounted_cash": 698.0, "minimum": 214.032, "maximum": 713.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 713.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 713.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 713.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 713.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 713.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC USE OF SPEECH DEVICE SERVICE, 15MIN", "code_information": [ { "code": "92609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 953.44, "discounted_cash": 98.0, "minimum": 95.0, "maximum": 831.3997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 98.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.34, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 95.48, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 98.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 98.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 166.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6220) GAUZE >16 <=48 SQ IN W/BORDR - A6220 - 27200124", "code_information": [ { "code": "A6220", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.5859, "maximum": 6.2405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.59, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37586.0, "minimum": 34656.48, "maximum": 86812.9323, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 37586.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53431.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 86812.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 36108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36108.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 62343.2 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37586.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34656.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37586.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62343.2 } ] } ] }, { "description": "HC DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY", "code_information": [ { "code": "27600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7460.94, "discounted_cash": 3228.0, "minimum": 2238.282, "maximum": 7460.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7460.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7460.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7460.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ACTIVATED PROT C (APC) RESISTNCE ASSAY", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.56, "discounted_cash": 15.0, "minimum": 14.888, "maximum": 206.2803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.61, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 113.7, "10th_percentile": 113.7, "90th_percentile": 113.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INS PICC RS&I W/O PORT 5YR+", "code_information": [ { "code": "36573", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6460.94, "discounted_cash": 1553.0, "minimum": 1553.22, "maximum": 6460.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6119.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6460.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5946.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4331) EXTENSION DRAINAGE TUBING", "code_information": [ { "code": "A4331", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.4023, "maximum": 7.6611, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BONE MARROW; ASPIRATION ONLY", "code_information": [ { "code": "38220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 865.63, "discounted_cash": 1629.0, "minimum": 259.689, "maximum": 865.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 865.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 5% - 00264751010 - 25800001", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00264751010", "type": "NDC" }, { "code": "J7070", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.826, "maximum": 7.826, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83 } ] } ] }, { "description": "HC ERCP,SPHINCTEROTOMY", "code_information": [ { "code": "43262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7151.56, "discounted_cash": 3804.0, "minimum": 2145.468, "maximum": 7151.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4146.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6433.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TP53 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS", "code_information": [ { "code": "81352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2250.0, "discounted_cash": 329.0, "minimum": 320.2178, "maximum": 1962.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 320.22, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1729.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 359.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 557.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16923.0, "minimum": 14037.84, "maximum": 37718.984, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16281.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37718.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16281.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16281.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26891.08 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16923.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14037.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16923.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26891.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16281.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16923.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16281.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23215.39 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16911.0, "minimum": 14783.27, "maximum": 46777.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37690.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46777.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16911.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14783.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16911.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46777.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16911.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16269.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23197.6 } ] } ] }, { "description": "HC AMPUTATION METATARSAL + TOE,SINGLE", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7110.0, "discounted_cash": 3228.0, "minimum": 2133.0, "maximum": 7110.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7110.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7110.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7110.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAINAGE OF GUM LESION", "code_information": [ { "code": "41800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 435.63, "discounted_cash": 131.0, "minimum": 130.689, "maximum": 435.63, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 435.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC PERQ TCAT PLMT NTRAC ST 2+LES 2+ST 2+C SEGMENTS", "code_information": [ { "code": "92930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1832) KNEE ORTHOS IMMOBLZR ADJUST PREFAB", "code_information": [ { "code": "L1832", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 912.0, "minimum": 886.4662, "maximum": 1542.6957, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1108.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 886.47, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 994.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1542.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MPL GENE ANALYSIS SEQUENCE ANALYSIS EXON 10", "code_information": [ { "code": "81339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1144.06, "discounted_cash": 185.0, "minimum": 179.9774, "maximum": 997.6203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 224.96, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 179.98, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 971.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 313.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAYS FOR BONE AGE", "code_information": [ { "code": "77072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.94, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 550.1797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 381.0, "10th_percentile": 381.0, "90th_percentile": 381.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS", "code_information": [ { "code": "52001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11644.1, "discounted_cash": 3478.0, "minimum": 3478.1, "maximum": 11644.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11644.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11644.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11644.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3791.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5882.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD BODY/SCALP/EXTR >30.1 CM", "code_information": [ { "code": "12037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1836.25, "discounted_cash": 2035.0, "minimum": 550.875, "maximum": 1836.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HELMINTH, ANTIBODY", "code_information": [ { "code": "86682", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.5, "discounted_cash": 13.0, "minimum": 12.6431, "maximum": 132.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF INORGANIC PHOSPHORUS", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.0, "discounted_cash": 4.0, "minimum": 4.6063, "maximum": 52.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 32.26, "10th_percentile": 32.26, "90th_percentile": 38.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.76, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 30.58, "10th_percentile": 30.58, "90th_percentile": 61.16, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 32.91, "10th_percentile": 32.29, "90th_percentile": 32.91, "count": "16" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.19, "10th_percentile": 21.19, "90th_percentile": 38.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 41.86, "10th_percentile": 24.79, "90th_percentile": 42.24, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT NECK TISSUE COMBO", "code_information": [ { "code": "70492", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3603.13, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 3141.9294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1328.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT", "code_information": [ { "code": "62328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3506.56, "discounted_cash": 696.0, "minimum": 696.49, "maximum": 3333.1922, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTRAOPERATIVE CYTO PATH CONSULT, ADD SITES", "code_information": [ { "code": "88334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.38, "minimum": 37.314, "maximum": 124.38, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.38 } ] } ] }, { "description": "HC ADRENAL IMAGING CORTEX &/MEDULLA", "code_information": [ { "code": "78075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1501.88, "discounted_cash": 1277.0, "minimum": 450.564, "maximum": 1501.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1501.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1501.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1501.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1501.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1392.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1501.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE SODIUM", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.13, "discounted_cash": 5.0, "minimum": 4.9173, "maximum": 55.0494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 22.62, "10th_percentile": 22.62, "90th_percentile": 22.62, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 34.62, "10th_percentile": 34.62, "90th_percentile": 34.62, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 44.04, "10th_percentile": 44.04, "90th_percentile": 44.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6539.0, "minimum": 5152.24, "maximum": 20909.2825, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13046.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12485.01 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6539.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5152.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6539.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12485.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6539.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6317.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8029.85 } ] } ] }, { "description": "OTHER HEART ASSIST SYSTEM IMPLANT", "code_information": [ { "code": "215", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 76774.0, "minimum": 73330.11, "maximum": 202688.1901, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 73711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 179921.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 73711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 73711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 132146.61 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 76774.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73330.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 76774.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 132147.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 73711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 76774.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 73711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 110738.57 } ] } ] }, { "description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "622", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28117.0, "minimum": 25899.62, "maximum": 98498.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 64314.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 98498.66 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28117.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25899.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28117.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 98498.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28117.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27022.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39584.28 } ] } ] }, { "description": "HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG", "code_information": [ { "code": "32408", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5710.94, "discounted_cash": 1629.0, "minimum": 1629.64, "maximum": 5710.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5710.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5710.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5710.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L4387) NON-PNEUM WALK BOOT PRE OTS", "code_information": [ { "code": "L4387", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 190.0, "minimum": 184.7975, "maximum": 321.5986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 230.99, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 184.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 207.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 321.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [ { "code": "405", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42653.0, "minimum": 37573.82, "maximum": 166549.9009, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40970.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 98851.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 40970.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 40970.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 103219.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 42653.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37573.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42653.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 103220.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40970.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 42653.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40970.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 60841.15 } ] } ] }, { "description": "HC MACROSCOPIC EXAM, ARTHROPOD", "code_information": [ { "code": "87168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.63, "discounted_cash": 4.0, "minimum": 4.1496, "maximum": 35.4294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INHIBIN A", "code_information": [ { "code": "86336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294.69, "discounted_cash": 15.0, "minimum": 15.1504, "maximum": 256.9697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4413) 2 PC DRAINABLE OST POUCH", "code_information": [ { "code": "A4413", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.6286, "maximum": 13.2759, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.63, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6248) HYDROGEL DRSG GEL FILLER - A6248 - 27100089", "code_information": [ { "code": "A6248", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "minimum": 22.4972, "maximum": 39.1513, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC XRAY SPINE, COMPLETE, 1 VW", "code_information": [ { "code": "72081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 431.25, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 121.05, "10th_percentile": 121.05, "90th_percentile": 121.05, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1220) ANTERIOR THORACIC EXTENSION", "code_information": [ { "code": "L1220", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 254.0, "minimum": 247.4008, "maximum": 430.5457, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 254.58, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.4, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 254.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 254.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 254.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 254.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 430.55, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEMO &/OR EVAL,PT USE,AEROSOL DEVICE", "code_information": [ { "code": "94664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.5, "discounted_cash": 216.0, "minimum": 24.75, "maximum": 82.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8509) TRACH-ESOPH VOICE PROS MD IN", "code_information": [ { "code": "L8509", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 131.0, "minimum": 127.539, "maximum": 221.9531, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 131.24, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 159.42, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 127.54, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 221.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SKULL <4 VW", "code_information": [ { "code": "70250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 490.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 490.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 490.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Gentamicin Sulfate Inj 10 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323017301", "type": "NDC" }, { "code": "J1580", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.3105, "maximum": 5.3105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 38.53, "10th_percentile": 38.53, "90th_percentile": 38.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.31 } ] } ] }, { "description": "RECTAL RESECTION WITH MCC", "code_information": [ { "code": "332", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28584.0, "minimum": 24008.02, "maximum": 78304.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27470.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 65425.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27470.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27470.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 78304.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28584.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24008.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28584.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78304.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27470.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28584.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27470.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40268.27 } ] } ] }, { "description": "HC EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV", "code_information": [ { "code": "64788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9281.56, "discounted_cash": 1926.0, "minimum": 1926.75, "maximum": 9220.8475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7590.62, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9220.85, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7376.95, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2100.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3258.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CRITICAL CARE, E/M 30-74 MINUTES", "code_information": [ { "code": "99291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5241.25, "discounted_cash": 815.0, "minimum": 815.04, "maximum": 4570.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 815.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3210.93, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3900.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 815.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3120.54, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 4107.13, "10th_percentile": 4107.13, "90th_percentile": 4107.13, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 815.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 815.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 815.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 888.39, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 815.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 815.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3656.29, "10th_percentile": 3656.29, "90th_percentile": 3656.29, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 815.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 815.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 815.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1378.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COMPATIBILITY TEST,ANTIGLOB TECH", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 168.0, "minimum": 76.5, "maximum": 255.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 233.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US,TRANSPLANTED KIDNEY, REAL TIME/ DOPPLER", "code_information": [ { "code": "76776", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1562.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1362.7703, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 982.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "Rabies Vaccine, PCEC For Inj", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50632001001", "type": "NDC" }, { "code": "90675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 315.0, "minimum": 304.8342, "maximum": 1241.8368, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1461.1, "10th_percentile": 1461.1, "90th_percentile": 1461.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1241.84, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 381.03, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 304.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1690.26, "10th_percentile": 1690.26, "90th_percentile": 1690.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 682.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 343.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 533.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT GUIDANCE NEEDLE PLACEMENT", "code_information": [ { "code": "77012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2223.44, "minimum": 620.08, "maximum": 1938.8397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 226.67, "10th_percentile": 226.67, "90th_percentile": 226.67, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1153.15, "10th_percentile": 1153.15, "90th_percentile": 1356.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 620.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1476.64, "10th_percentile": 1476.64, "90th_percentile": 1476.64, "count": "1 through 10" } ] } ] }, { "description": "Papaverine HCl Inj 30 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "54288014201", "type": "NDC" }, { "code": "J2440", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.752, "maximum": 2.752, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.75 } ] } ] }, { "description": "HC INSERT ART & VENTR PM W TRANSVENOUS ELECTROD", "code_information": [ { "code": "33208", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47866.9, "discounted_cash": 10313.0, "minimum": 10313.01, "maximum": 47866.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40629.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47866.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39485.42, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11241.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17441.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY NEOPLASMS WITH MCC", "code_information": [ { "code": "180", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14479.0, "minimum": 12097.1, "maximum": 34933.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13935.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31911.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13935.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13935.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34933.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14479.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12097.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14479.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34933.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 34379.81, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15200.4, "10th_percentile": 15200.4, "90th_percentile": 15200.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13935.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14479.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13935.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19640.89 } ] } ] }, { "description": "HC TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS", "code_information": [ { "code": "33418", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19025.6, "minimum": 2944.0066, "maximum": 16590.3232, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2944.01 } ] } ] }, { "description": "HC X-RAY SACRUM/COCCYX 2+ VW", "code_information": [ { "code": "72220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.88, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 564.0794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 390.6, "10th_percentile": 390.6, "90th_percentile": 390.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 328.1, "10th_percentile": 328.1, "90th_percentile": 328.1, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 379.57, "10th_percentile": 379.57, "90th_percentile": 379.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 95.97, "10th_percentile": 95.97, "90th_percentile": 95.97, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 396.72, "10th_percentile": 374.29, "90th_percentile": 429.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN - G0463 - 76100009", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.56, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 291.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 291.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 291.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cosyntropin For Inj 0.25 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00548590000", "type": "NDC" }, { "code": "J0834", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 71.81, "maximum": 71.81, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.81 } ] } ] }, { "description": "HC ASSAY OF BLOOD CHLORIDE", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.19, "discounted_cash": 4.0, "minimum": 4.4703, "maximum": 41.1497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.37, "10th_percentile": 25.37, "90th_percentile": 30.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 24.05, "10th_percentile": 24.05, "90th_percentile": 24.05, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 25.88, "10th_percentile": 25.88, "90th_percentile": 25.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 32.92, "10th_percentile": 32.92, "90th_percentile": 32.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EEG COMPLETE STD PHYS/QHP>84 HR W/O VID", "code_information": [ { "code": "96156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.13, "discounted_cash": 100.0, "minimum": 100.24, "maximum": 338.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 338.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 338.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 169.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INFLUENZA VIRUS", "code_information": [ { "code": "86710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.5, "discounted_cash": 13.0, "minimum": 13.1679, "maximum": 259.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.17, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LEGIONELLA", "code_information": [ { "code": "86713", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 306.88, "discounted_cash": 15.0, "minimum": 14.8685, "maximum": 267.5994, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.88, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CLOT INHIB PROTEIN C,ACTIV", "code_information": [ { "code": "85303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.25, "discounted_cash": 13.0, "minimum": 13.4497, "maximum": 293.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.81, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY STERNO-CLAVICLUAR JT", "code_information": [ { "code": "71130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 557.19, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 485.8697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dextrose 5% in Lactated Ringers", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338012504", "type": "NDC" }, { "code": "J7121", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.501, "maximum": 17.501, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.5 } ] } ] }, { "description": "HC CT SCAN,PELVIS,W/O CONTRAST", "code_information": [ { "code": "72192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2225.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1940.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1128.46, "10th_percentile": 1128.46, "90th_percentile": 1128.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 748.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1477.74, "10th_percentile": 1364.55, "90th_percentile": 1552.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAIN SPINAL CORD CYST, PERQ", "code_information": [ { "code": "62268", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1049.06, "discounted_cash": 872.0, "minimum": 314.718, "maximum": 1049.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, TEMPOROMANDIBULAR JOINT(S)", "code_information": [ { "code": "70336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1148.44, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1148.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1148.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NONSLCTV CATH THOR AORT ANGIO INTR/XTRCRANL ART", "code_information": [ { "code": "36221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9181.88, "discounted_cash": 3115.0, "minimum": 2754.564, "maximum": 9181.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ", "code_information": [ { "code": "49451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3029.06, "discounted_cash": 894.0, "minimum": 894.92, "maximum": 3029.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3029.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3029.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3029.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "257", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9354.0, "minimum": 5485.85, "maximum": 23619.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9018.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19735.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9018.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9018.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23619.8 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9354.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5485.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9354.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23619.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9018.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9354.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9018.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12147.1 } ] } ] }, { "description": "HC RELOCATE SKIN POCKET FOR PACEMAKER", "code_information": [ { "code": "33222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5832.19, "discounted_cash": 2035.0, "minimum": 1749.657, "maximum": 5832.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5832.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5832.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5832.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED", "code_information": [ { "code": "33016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6668.13, "discounted_cash": 1553.0, "minimum": 1553.22, "maximum": 6668.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6119.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6668.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5946.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Milrinone Lactate in Dextrose 5% IV Soln 20 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00143971901", "type": "NDC" }, { "code": "J2260", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.3755, "maximum": 3.3755, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.38 } ] } ] }, { "description": "HC X-RAY SINUSES 3+ VW", "code_information": [ { "code": "70220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 714.06, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 622.6603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5774.0, "minimum": 4257.31, "maximum": 16928.0678, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5582.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11228.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5582.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5582.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10182.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5774.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4257.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5774.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10182.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5582.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5774.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5582.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6911.01 } ] } ] }, { "description": "Nicardipine HCl IV Soln 2.5 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00143968901", "type": "NDC" }, { "code": "J2404", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CONTROL THROAT BLEEDING", "code_information": [ { "code": "42960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 591.56, "discounted_cash": 532.0, "minimum": 177.468, "maximum": 591.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 580.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BASIC METABOLIC PANEL CALCIUM TOTAL", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.56, "discounted_cash": 8.0, "minimum": 8.2214, "maximum": 197.5603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 136.8, "10th_percentile": 114.91, "90th_percentile": 136.8, "count": "81" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 115.46, "10th_percentile": 108.93, "90th_percentile": 115.46, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 121.93, "10th_percentile": 117.24, "90th_percentile": 121.93, "count": "125" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 37.82, "10th_percentile": 37.82, "90th_percentile": 114.91, "count": "39" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 150.48, "10th_percentile": 150.48, "90th_percentile": 158.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "989", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10168.0, "minimum": 7997.6, "maximum": 21669.3521, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9799.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21669.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9799.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9799.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20693.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10168.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7997.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10168.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20693.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9799.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10168.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9799.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13337.12 } ] } ] }, { "description": "HC RP LOCLZJ TUM SPECT 2 AREA 1D IMG/1 AREA IMG>2+D", "code_information": [ { "code": "78831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6793.44, "discounted_cash": 1277.0, "minimum": 1277.43, "maximum": 6113.3968, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5032.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6113.4, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4890.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4978.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1392.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2160.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Phenobarbital Sodium Inj 65 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641047621", "type": "NDC" }, { "code": "J2560", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 63.296, "maximum": 63.296, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.3 } ] } ] }, { "description": "HC CT SCAN OF PELVIS CONTRAST", "code_information": [ { "code": "72193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2424.38, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2114.0594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 694.95, "10th_percentile": 694.95, "90th_percentile": 694.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1479.26, "10th_percentile": 1479.26, "90th_percentile": 1479.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1585.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1402.69, "10th_percentile": 1402.69, "90th_percentile": 1402.69, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UNI", "code_information": [ { "code": "36251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9039.06, "discounted_cash": 3115.0, "minimum": 2711.718, "maximum": 9039.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine HCl Inj 0.5%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "63323046701", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC TISSUE EXAM BY KOH", "code_information": [ { "code": "87220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.0, "discounted_cash": 4.0, "minimum": 4.1496, "maximum": 100.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CMV ANTIBODY, IGM", "code_information": [ { "code": "86645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 362.81, "discounted_cash": 16.0, "minimum": 16.3748, "maximum": 316.3703, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 240.9, "10th_percentile": 240.9, "90th_percentile": 240.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.47, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.37, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4140) BIODFENCE 1CM", "code_information": [ { "code": "Q4140", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 363.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTRA-ATRIAL PACING", "code_information": [ { "code": "93610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3523.13, "discounted_cash": 7695.0, "minimum": 1056.939, "maximum": 3523.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF NOS VITAMIN", "code_information": [ { "code": "84591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.06, "discounted_cash": 17.0, "minimum": 16.5789, "maximum": 291.3003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.58, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ceftaroline Fosamil for IV Soln 600 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00456060001", "type": "NDC" }, { "code": "J0712", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.1107, "maximum": 16.7591, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.11, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6453) SELF-ADHER BAND W <3/YD - A6453 - 27100028", "code_information": [ { "code": "A6453", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.5221, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.09, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US, OB < 14 WKS, SINGLE FETUS", "code_information": [ { "code": "76801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 967.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 843.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 490.73, "10th_percentile": 490.73, "90th_percentile": 490.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 590.33, "10th_percentile": 567.7, "90th_percentile": 590.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 289.39, "10th_percentile": 275.53, "90th_percentile": 584.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 674.93, "10th_percentile": 296.68, "90th_percentile": 674.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEEDLE INSERTION W/O INJECTION 3 OR MORE MUSCLES", "code_information": [ { "code": "20561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.38, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 104.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 104.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7520) TRACH/LARYN TUBE NON-CUFFED", "code_information": [ { "code": "A7520", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 67.0, "minimum": 65.752, "maximum": 114.4266, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.19, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 65.75, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 67.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 67.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 67.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ESTRONE", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "discounted_cash": 24.0, "minimum": 24.2464, "maximum": 130.9176, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 111.53, "10th_percentile": 111.53, "90th_percentile": 111.53, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.31, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.25, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMV F.B.,EYE,CORNEA,SLIT LAMP", "code_information": [ { "code": "65222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 543.44, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 543.44, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 543.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" } ] } ] }, { "description": "Filgrastim-aafi Soln Prefilled Syringe 300 MCG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00069029101", "type": "NDC" }, { "code": "Q5110", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.1188, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ, THERAP/PROPH/DIAGN, IM OR SUBCUT", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.06, "discounted_cash": 71.0, "minimum": 50.718, "maximum": 169.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 111.89, "10th_percentile": 90.89, "90th_percentile": 133.2, "count": "11" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 169.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 169.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 130.7, "10th_percentile": 106.17, "90th_percentile": 321.35, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EVAL FNA SMEAR TO DETRMIN ADEQUACY, EA ADD EVAL", "code_information": [ { "code": "88177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.38, "minimum": 43.314, "maximum": 125.8994, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 316.75, "10th_percentile": 316.75, "90th_percentile": 316.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.15 } ] } ] }, { "description": "HC COMPLEMENT, ANTIGEN", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.44, "discounted_cash": 12.0, "minimum": 11.6616, "maximum": 142.5197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 98.6, "10th_percentile": 98.6, "90th_percentile": 165.65, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 83.29, "10th_percentile": 83.29, "90th_percentile": 333.16, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 87.96, "10th_percentile": 84.5, "90th_percentile": 175.91, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 53.64, "10th_percentile": 53.64, "90th_percentile": 53.64, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 114.01, "10th_percentile": 108.46, "90th_percentile": 228.03, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITH CC", "code_information": [ { "code": "164", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20244.0, "minimum": 17420.99, "maximum": 61599.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19467.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 45608.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19467.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19467.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46647.32 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 61458.04, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 37150.58, "10th_percentile": 37150.58, "90th_percentile": 37150.58, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20244.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17420.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20244.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46647.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19467.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20244.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19467.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28071.12 } ] } ] }, { "description": "HC DETECT AGENT, MULT ORGS, DNA, AMP", "code_information": [ { "code": "87801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.38, "discounted_cash": 70.0, "minimum": 68.2204, "maximum": 354.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 214.0, "10th_percentile": 179.76, "90th_percentile": 214.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.27, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 180.59, "10th_percentile": 180.59, "90th_percentile": 180.59, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 190.71, "10th_percentile": 190.71, "90th_percentile": 190.71, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 354.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 283.5, "10th_percentile": 283.5, "90th_percentile": 283.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 247.21, "10th_percentile": 235.4, "90th_percentile": 368.35, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36173.0, "minimum": 32197.34, "maximum": 134992.0371, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34752.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 83455.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34752.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34752.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 112269.58 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36173.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32197.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36173.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 112270.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34752.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 36173.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34752.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51365.48 } ] } ] }, { "description": "HC BPG OTH/THN VEIN ILIOFEMORAL", "code_information": [ { "code": "35665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6111.56, "minimum": 1833.468, "maximum": 6111.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6111.56 } ] } ] }, { "description": "HC REPR WND INTRMD FACE 12.6-20 CM", "code_information": [ { "code": "12055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1836.25, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 1836.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATH PLC/COR ANGIO RS/I W L HRT VENTRICULOGRPHY", "code_information": [ { "code": "93458", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 10503.5, "10th_percentile": 10257.19, "90th_percentile": 10881.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 17140.92, "10th_percentile": 17140.92, "90th_percentile": 17140.92, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 9873.53, "10th_percentile": 9873.53, "90th_percentile": 9873.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 10370.76, "10th_percentile": 10370.76, "90th_percentile": 10626.03, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 3147.15, "10th_percentile": 3147.15, "90th_percentile": 7048.46, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 6569.48, "10th_percentile": 4827.4, "90th_percentile": 12232.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "988", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13548.0, "minimum": 11877.0, "maximum": 53073.616, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13548.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30111.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13042.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13548.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13042.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18279.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13042.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29699.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13042.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13042.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30111.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13548.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11877.0 } ] } ] }, { "description": "HC ASSAY OF TROPONIN, QUANT", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.13, "discounted_cash": 12.0, "minimum": 12.1183, "maximum": 216.3694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 133.39, "10th_percentile": 133.39, "90th_percentile": 133.39, "count": "12" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 151.46, "10th_percentile": 151.46, "90th_percentile": 151.46, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 136.09, "10th_percentile": 133.53, "90th_percentile": 272.18, "count": "57" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 55.74, "10th_percentile": 55.74, "90th_percentile": 133.39, "count": "19" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 173.1, "10th_percentile": 173.09, "90th_percentile": 346.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME", "code_information": [ { "code": "76000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 663.13, "discounted_cash": 235.0, "minimum": 198.939, "maximum": 663.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 663.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 663.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 663.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 463.47, "10th_percentile": 463.47, "90th_percentile": 463.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6210) FOAM DRG >16<=48 SQ IN W/O B - A6210 - 27200119", "code_information": [ { "code": "A6210", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 28.0, "minimum": 27.5991, "maximum": 48.0301, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SPINAL CORD NEEDLE BIOPSY, PERQ", "code_information": [ { "code": "62269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2092.5, "discounted_cash": 1629.0, "minimum": 627.75, "maximum": 2092.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2092.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2092.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2092.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2092.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10247.0, "minimum": 8504.24, "maximum": 26819.3218, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21857.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22296.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10247.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8504.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10247.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22296.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10247.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9875.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13452.78 } ] } ] }, { "description": "Furosemide Inj 10 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "23155047331", "type": "NDC" }, { "code": "J1938", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC FATS/LIPIDS, FECES, QUALITATIVE", "code_information": [ { "code": "82705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.19, "discounted_cash": 5.0, "minimum": 4.9562, "maximum": 154.5097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 22.8, "10th_percentile": 22.8, "90th_percentile": 22.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Tab 0.5 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00054417925", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Oxytocin-Sodium Chloride 0.9% IV Soln 30 Unit/500ML", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "71139001201", "type": "NDC" }, { "code": "J2590", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.0745, "maximum": 3.0745, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.07 } ] } ] }, { "description": "HC CANDIDA, ANTIBODY", "code_information": [ { "code": "86628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.75, "discounted_cash": 12.0, "minimum": 11.6713, "maximum": 43.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO SPINAL SELECTV", "code_information": [ { "code": "75705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4651.25, "discounted_cash": 5490.0, "minimum": 1190.4998, "maximum": 4651.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1190.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4651.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19615.0, "minimum": 16385.56, "maximum": 54734.6465, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18864.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44113.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18864.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18864.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 49415.92 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19615.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16385.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19615.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49415.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18864.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19615.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18864.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27151.36 } ] } ] }, { "description": "HC INSERT NON-TUNNEL CV CATH <5 YR", "code_information": [ { "code": "36555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 521.25, "discounted_cash": 3115.0, "minimum": 156.375, "maximum": 521.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 521.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR TONGUE LACER,>2.6 CM/COMPLX", "code_information": [ { "code": "41252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2236.88, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 1950.5594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1118.42, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 894.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT", "code_information": [ { "code": "34703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5709.69, "minimum": 1712.907, "maximum": 5709.69, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 5709.69 } ] } ] }, { "description": "Sumatriptan Succinate Inj 6 MG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00143963801", "type": "NDC" }, { "code": "J3030", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 81.141, "maximum": 81.141, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.14 } ] } ] }, { "description": "HC X-RAY FACIAL BONES 3+ VW", "code_information": [ { "code": "70150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 570.31, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 497.3103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 307.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CCMCC", "code_information": [ { "code": "538", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6526.0, "minimum": 4647.67, "maximum": 15577.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6304.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13015.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6304.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6304.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15577.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6526.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4647.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6526.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15577.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6304.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6526.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6304.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8010.95 } ] } ] }, { "description": "Phenobarbital Sodium Inj 130 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "42494041601", "type": "NDC" }, { "code": "J2560", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 63.296, "maximum": 63.296, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.3 } ] } ] }, { "description": "HC (SUP SHELL A6235) HYDROCOLLD DRG >16<=48 W/O B - A6235 - 27200132", "code_information": [ { "code": "A6235", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "minimum": 23.294, "maximum": 40.5381, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.13, "discounted_cash": 11.0, "minimum": 11.2049, "maximum": 159.6894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 122.6, "10th_percentile": 99.12, "90th_percentile": 211.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 103.08, "10th_percentile": 103.08, "90th_percentile": 103.08, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 4", "code_information": [ { "code": "81403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2329.69, "discounted_cash": 185.0, "minimum": 179.9774, "maximum": 2031.4897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 224.96, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 179.98, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 971.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 313.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EVASC RPR DPLMNT ILIO-ILIAC NDGFT", "code_information": [ { "code": "34707", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6886.25, "minimum": 2065.875, "maximum": 6886.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6886.25 } ] } ] }, { "description": "HC PERC CLOS,CONG INTERATRIAL COMMUN W/IMPL", "code_information": [ { "code": "93580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67787.8, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 67787.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67787.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67787.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 67787.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BRONCHOSCOPY DIAG", "code_information": [ { "code": "31622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4785.31, "discounted_cash": 1756.0, "minimum": 1435.593, "maximum": 4785.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4785.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4785.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4785.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2970.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RAD GUIDED,PERCUT DRAINAGE,W/CATH PLACE", "code_information": [ { "code": "75989", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2751.56, "minimum": 500.2154, "maximum": 2399.3603, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 500.22 } ] } ] }, { "description": "HC INSERT PESSARY/OTHER DEVICE", "code_information": [ { "code": "57160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.88, "discounted_cash": 199.0, "minimum": 199.48, "maximum": 821.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 785.87, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 821.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 763.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 337.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ELEC STIM OTHER THAN WOUND - G0238 - 42000014", "code_information": [ { "code": "G0238", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.63, "discounted_cash": 28.0, "minimum": 24.189, "maximum": 80.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52240.0, "minimum": 47260.92, "maximum": 131321.0, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 50169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 131320.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 52240.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47260.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52240.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 131321.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 50169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 52240.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 50169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 74861.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 50169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 121629.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 50169.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBODY JOHN CUNNINGHAM VIRUS", "code_information": [ { "code": "86711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2140.94, "discounted_cash": 16.0, "minimum": 16.4137, "maximum": 1866.8997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.41, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7407.0, "minimum": 5164.7, "maximum": 18743.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7150.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15110.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7150.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7150.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18743.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7407.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5164.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7407.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18743.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7150.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7407.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7150.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9299.95 } ] } ] }, { "description": "HC PATH CONSULT IN SURG,W FRZ SEC", "code_information": [ { "code": "88331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 490.94, "discounted_cash": 168.0, "minimum": 147.282, "maximum": 490.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 160.65, "10th_percentile": 160.65, "90th_percentile": 481.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 490.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 490.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 490.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 342.48, "10th_percentile": 342.48, "90th_percentile": 342.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC", "code_information": [ { "code": "43762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1301.88, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1179.8186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FMR1 GENE ANAL CHARACTERIZATION OF ALLELES", "code_information": [ { "code": "81244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1736.88, "discounted_cash": 44.0, "minimum": 43.6241, "maximum": 1514.5594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.53, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.62, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hydromorphone HCl-Sodium Chloride 0.9% Inj 6 MG/30ML - 99999263401 - 25000001", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "99999263401", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.98, "10th_percentile": 11.99, "90th_percentile": 39.11, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 44.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "Hydralazine HCl Inj 20 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55150040001", "type": "NDC" }, { "code": "J0360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.46, "maximum": 9.46, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 36.34, "10th_percentile": 36.34, "90th_percentile": 36.34, "count": "1 through 10" } ] } ] }, { "description": "HC TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I", "code_information": [ { "code": "36907", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24531.6, "minimum": 7359.48, "maximum": 21391.5552, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 24691.04, "10th_percentile": 24691.04, "90th_percentile": 24691.04, "count": "1 through 10" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6523.0, "minimum": 4937.68, "maximum": 15844.2615, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6302.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13010.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6302.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6302.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12843.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6523.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4937.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6523.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12843.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6302.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6523.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6302.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8007.61 } ] } ] }, { "description": "HC CHANGE OF URETEROSTOMY TUBE VIA ILEAL CONDUIT", "code_information": [ { "code": "50688", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2819.38, "discounted_cash": 2062.0, "minimum": 845.814, "maximum": 2819.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2819.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2819.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2819.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2819.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST", "code_information": [ { "code": "71260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3165.31, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2760.1503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1605.41, "10th_percentile": 452.99, "90th_percentile": 1605.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1931.35, "10th_percentile": 1857.21, "90th_percentile": 1931.35, "count": "18" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1023.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2102.32, "10th_percentile": 1235.61, "90th_percentile": 2208.12, "count": "27" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CCMCC", "code_information": [ { "code": "013", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22965.0, "minimum": 18341.52, "maximum": 57591.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22078.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 52073.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22078.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22078.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 57591.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22965.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18341.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22965.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57591.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22078.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22965.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22078.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32050.46 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18355.0, "minimum": 14931.39, "maximum": 74798.7892, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17655.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18355.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17655.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25309.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17655.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 41121.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17655.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 65423.21, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 29835.27, "10th_percentile": 29835.27, "90th_percentile": 29835.27, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17655.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39752.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18355.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14931.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18355.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39752.1 } ] } ] }, { "description": "HC MRI LUMBAR SPINE CONTRAST", "code_information": [ { "code": "72149", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2657.81, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2317.6103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1621.69, "10th_percentile": 1621.69, "90th_percentile": 1621.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1708.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM", "code_information": [ { "code": "93260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.69, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 159.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 159.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14083.0, "minimum": 11546.16, "maximum": 39048.7948, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 35152.87, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 37258.61, "10th_percentile": 37258.61, "90th_percentile": 37258.61, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13556.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30971.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13556.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13556.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32219.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14083.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11546.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14083.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32219.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13556.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14083.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13556.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19062.56 } ] } ] }, { "description": "HC (SUP SHELL A4406) PECTIN BASED OSTOMY PASTE", "code_information": [ { "code": "A4406", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 7.9299, "maximum": 13.8002, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.93, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0482) TLSO RIGID LINED CUSTOM FAB", "code_information": [ { "code": "L0482", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1996.0, "minimum": 1940.636, "maximum": 3377.2418, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1996.95, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2425.7, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1940.64, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2176.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3377.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8843.0, "minimum": 7152.5, "maximum": 25638.6387, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 23080.66, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 2182.2, "10th_percentile": 2182.2, "90th_percentile": 2182.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8528.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18521.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8528.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 22495.55, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 58086.08, "10th_percentile": 58086.08, "90th_percentile": 58086.08, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8528.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15812.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8843.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7152.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8843.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15812.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8528.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8843.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8528.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11399.72 } ] } ] }, { "description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC", "code_information": [ { "code": "511", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16862.0, "minimum": 13574.11, "maximum": 70893.1902, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16222.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37574.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16222.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16222.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 58590.68 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16862.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13574.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16862.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58590.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16222.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16862.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16222.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23126.42 } ] } ] }, { "description": "HC (SUP SHELL A6448) LT COMPRES BAND <3/YD - A6448 - 27090038", "code_information": [ { "code": "A6448", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.5938, "maximum": 2.7736, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.59, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRUG SCREEN QUANT CAFFEINE", "code_information": [ { "code": "80155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 484.69, "discounted_cash": 38.0, "minimum": 37.4823, "maximum": 422.6497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.48, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42800.0, "minimum": 23085.0081, "maximum": 134822.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41111.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 99201.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 41111.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 41111.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 134821.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 42800.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38256.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42800.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 134822.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41111.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 42800.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41111.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61056.91 } ] } ] }, { "description": "HC (SUP SHELL C2639) BRACHYTX, NON-STRANDED,I-125", "code_information": [ { "code": "C2639", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 36.0, "minimum": 36.46, "maximum": 174.4866, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 143.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 174.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 139.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Perphenazine Tab 2 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904659961", "type": "NDC" }, { "code": "Q0175", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.2624, "maximum": 1.2624, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.26 } ] } ] }, { "description": "Fondaparinux Sodium Subcutaneous Inj 7.5 MG/0.6ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55111068011", "type": "NDC" }, { "code": "J1652", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.849, "maximum": 1.849, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.85 } ] } ] }, { "description": "HC PLCMT URETERAL STENT, EXISTING ACCESS", "code_information": [ { "code": "50693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11736.6, "discounted_cash": 3478.0, "minimum": 3478.1, "maximum": 11736.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11736.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11736.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11736.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3791.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5882.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMHISTOCHEM/CYTCHM PER SEP, EA MULTPLX AB STAIN", "code_information": [ { "code": "88344", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.13, "discounted_cash": 353.0, "minimum": 81.939, "maximum": 273.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 218.5, "10th_percentile": 218.5, "90th_percentile": 218.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 218.5, "10th_percentile": 218.5, "90th_percentile": 218.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6203) COMPOSITE DRSG <= 16 SQ IN - A6203 - 27200115", "code_information": [ { "code": "A6203", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.6646, "maximum": 8.1178, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ XHEPATIC PORTO+DYNAMIC", "code_information": [ { "code": "75885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9553.75, "discounted_cash": 3115.0, "minimum": 634.7443, "maximum": 9553.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9553.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9553.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9553.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 634.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC I&D PERIANAL ABSCESS,SUPERFICIAL", "code_information": [ { "code": "46050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2540.63, "discounted_cash": 917.0, "minimum": 762.189, "maximum": 2540.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2540.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2540.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2540.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1000.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1551.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC M.TUBERCULO, DNA, AMP PROBE", "code_information": [ { "code": "87556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 491.25, "discounted_cash": 41.0, "minimum": 40.5046, "maximum": 428.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LACTATE (LD) (LDH) ENZYME", "code_information": [ { "code": "83615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.5, "discounted_cash": 6.0, "minimum": 5.8697, "maximum": 111.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 68.54, "10th_percentile": 68.54, "90th_percentile": 68.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 64.97, "10th_percentile": 64.97, "90th_percentile": 84.46, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 68.62, "10th_percentile": 68.62, "90th_percentile": 68.62, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 88.94, "10th_percentile": 6.04, "90th_percentile": 89.76, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOGRAM EPIDURAL", "code_information": [ { "code": "75872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1760.31, "discounted_cash": 618.0, "minimum": 528.093, "maximum": 1760.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1760.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1760.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1760.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 658.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER FACTORS INFLUENCING HEALTH STATUS", "code_information": [ { "code": "951", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5276.0, "minimum": 3833.0774, "maximum": 11109.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5105.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 10046.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5105.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5105.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11109.47 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5276.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3924.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5276.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11109.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5105.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5276.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5105.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6183.65 } ] } ] }, { "description": "HC APPLY LONG ARM SPLINT", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 540.31, "discounted_cash": 160.0, "minimum": 160.33, "maximum": 540.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 540.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 540.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 540.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, DORSAL SPINE COMBO", "code_information": [ { "code": "72157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3195.63, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2786.5894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1717.97, "10th_percentile": 1717.97, "90th_percentile": 1717.97, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1987.42, "10th_percentile": 1987.42, "90th_percentile": 1987.42, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1950.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 858.24, "10th_percentile": 858.24, "90th_percentile": 858.24, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2249.72, "10th_percentile": 2249.72, "90th_percentile": 2249.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CORTISOL, FREE", "code_information": [ { "code": "82530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.38, "discounted_cash": 16.0, "minimum": 16.2388, "maximum": 69.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 38.05, "10th_percentile": 38.05, "90th_percentile": 38.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 55.5, "10th_percentile": 55.5, "90th_percentile": 55.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [ { "code": "573", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50873.0, "minimum": 42622.93, "maximum": 141686.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48858.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 118382.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 48858.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48858.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 141685.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 50873.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42622.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50873.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 141686.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48858.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 50873.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 48858.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 72862.57 } ] } ] }, { "description": "HC RBC LEUKOCYTES REDUCED", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 993.44, "discounted_cash": 184.0, "minimum": 184.0, "maximum": 880.5688, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 534.07, "10th_percentile": 534.07, "90th_percentile": 534.07, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 724.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 880.57, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 704.48, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 609.26, "10th_percentile": 609.26, "90th_percentile": 1218.51, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 693.02, "10th_percentile": 609.26, "90th_percentile": 693.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 311.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TESTICULAR IMAGING & FLOW", "code_information": [ { "code": "78761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 746.25, "discounted_cash": 394.0, "minimum": 223.875, "maximum": 746.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 746.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 746.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 746.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 746.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX", "code_information": [ { "code": "61020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1038.44, "discounted_cash": 872.0, "minimum": 311.532, "maximum": 1038.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1038.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1038.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1038.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1038.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD CULTURE FOR BACTERIA", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.31, "discounted_cash": 10.0, "minimum": 10.029, "maximum": 218.2703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 127.01, "10th_percentile": 127.01, "90th_percentile": 254.02, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 259.16, "10th_percentile": 134.71, "90th_percentile": 269.42, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 254.02, "10th_percentile": 254.02, "90th_percentile": 254.02, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 332.64, "10th_percentile": 332.64, "90th_percentile": 349.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A2005) MICROLYTE MATRIX, PER SQ CM", "code_information": [ { "code": "A2005", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY BILE/PANCREAS ENDOSCOPY", "code_information": [ { "code": "74330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2076.88, "minimum": 623.064, "maximum": 1811.0394, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 631.84 } ] } ] }, { "description": "HC (SUP SHELL A2009) SYMPHONY, PER SQ CM", "code_information": [ { "code": "A2009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT STERNUM FX", "code_information": [ { "code": "21820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.13, "discounted_cash": 243.0, "minimum": 81.939, "maximum": 273.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM LUNG PERFUSION IMAGING", "code_information": [ { "code": "78580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1223.13, "discounted_cash": 394.0, "minimum": 366.939, "maximum": 1223.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1223.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1223.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1223.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1223.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine HCl Preservative Free (PF) Inj 0.75%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409116518", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT", "code_information": [ { "code": "78483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.38, "discounted_cash": 535.0, "minimum": 125.814, "maximum": 419.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 419.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 419.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UPGRADE/CONVERS PACEMAKER SYS, SINGLE TO DUAL", "code_information": [ { "code": "33214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47866.9, "discounted_cash": 10313.0, "minimum": 10313.01, "maximum": 47866.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40629.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47866.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39485.42, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11241.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17441.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NON-INV PHYSIOLOGIC STD EXTREM ART 3 LVLS, COMP", "code_information": [ { "code": "93923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 910.31, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 910.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 910.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 203.61, "10th_percentile": 203.61, "90th_percentile": 203.61, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3808) WHFO, RIGID W/O JOINTS", "code_information": [ { "code": "L3808", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 461.0, "minimum": 448.165, "maximum": 779.9307, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 461.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 461.17, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 560.18, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 461.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 448.17, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 461.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 461.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 461.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 502.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 461.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 461.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 461.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 461.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 461.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 779.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Nafcillin Sodium For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55150012215", "type": "NDC" }, { "code": "J2290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC DSTR CUT VSC PRLF LES<10SQCM", "code_information": [ { "code": "17106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1366.88, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 1366.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1366.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1366.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1366.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN E", "code_information": [ { "code": "84446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.44, "discounted_cash": 14.0, "minimum": 13.7801, "maximum": 151.2397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 63.38, "10th_percentile": 63.38, "90th_percentile": 63.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.22, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 88.38, "10th_percentile": 88.38, "90th_percentile": 88.38, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 95.13, "10th_percentile": 93.34, "90th_percentile": 95.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 63.38, "10th_percentile": 63.38, "90th_percentile": 111.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 122.1, "10th_percentile": 120.99, "90th_percentile": 122.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY EYE FOR FOREIGN BODY", "code_information": [ { "code": "70030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 423.75, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 202.72, "10th_percentile": 202.72, "90th_percentile": 202.72, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLADDER INSTILLATION ANTICARCINOGENIC AGENT", "code_information": [ { "code": "51720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 622.19, "discounted_cash": 688.0, "minimum": 186.657, "maximum": 622.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN,CERVICAL SPINE,W/O CONTRAST", "code_information": [ { "code": "72125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2131.88, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1858.9994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1250.84, "10th_percentile": 1250.84, "90th_percentile": 1300.78, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 760.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 337.57, "10th_percentile": 337.57, "90th_percentile": 337.57, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1415.92, "10th_percentile": 653.72, "90th_percentile": 1487.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 337.4, "10th_percentile": 337.4, "90th_percentile": 1081.25, "count": "1 through 10" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN - 99212 - 76100007", "code_information": [ { "code": "99212", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.25, "minimum": 66.375, "maximum": 192.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 141.6, "10th_percentile": 141.6, "90th_percentile": 141.6, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 138.95, "10th_percentile": 138.95, "90th_percentile": 140.18, "count": "1 through 10" } ] } ] }, { "description": "HC TIXAGEV AND CILGAVE INFUSION AND MONITORING", "code_information": [ { "code": "M0220", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.19, "discounted_cash": 145.0, "minimum": 83.157, "maximum": 277.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 277.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 277.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 277.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 145.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 145.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 158.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 145.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 245.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT RADIAL SHAFT FX WO AMNIP", "code_information": [ { "code": "25500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4346) CATH INDW FOLEY 3 WAY - A4346 - RU278117", "code_information": [ { "code": "A4346", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "minimum": 23.0511, "maximum": 40.1153, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.05, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL OF CLOT IN GRAFT", "code_information": [ { "code": "35875", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13170.3, "discounted_cash": 5490.0, "minimum": 3951.09, "maximum": 13170.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13170.3, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13170.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13170.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14697.0, "minimum": 13084.08, "maximum": 45723.6518, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14145.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32429.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14145.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14145.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31865.21 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14697.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13084.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31865.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14145.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14697.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14145.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19960.08 } ] } ] }, { "description": "Heparin Sodium (Porcine) Inj 1000 Unit/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "71288040210", "type": "NDC" }, { "code": "J1644", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 14.48, "10th_percentile": 11.99, "90th_percentile": 68.71, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 16.2, "count": "1 through 10" } ] } ] }, { "description": "HC CREATINE, MB FRACTION", "code_information": [ { "code": "82553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 262.81, "discounted_cash": 11.0, "minimum": 11.2243, "maximum": 229.1703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 185.02, "10th_percentile": 185.02, "90th_percentile": 185.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, PELVIS, COMBO", "code_information": [ { "code": "72197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4086.25, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 3563.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2016.5, "10th_percentile": 2016.5, "90th_percentile": 2016.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2138.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC", "code_information": [ { "code": "686", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14765.0, "minimum": 13051.55, "maximum": 49832.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14211.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32592.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14211.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14211.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 49832.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14765.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13051.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14765.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49832.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14211.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14765.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14211.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20060.17 } ] } ] }, { "description": "HC EXC SKIN BENIG <0.5 CM FACE/HEAD/MUCUS", "code_information": [ { "code": "11440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2021.56, "discounted_cash": 698.0, "minimum": 606.468, "maximum": 2021.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2021.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2021.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2021.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITH CC", "code_information": [ { "code": "032", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17255.0, "minimum": 14781.19, "maximum": 40833.45, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38506.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16599.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16599.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40833.45 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17255.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14781.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17255.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40833.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16599.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17255.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16599.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23700.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16599.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC REPOSIT PREV IMPLANTED CARDIAC ELECTRODE", "code_information": [ { "code": "33226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7560.31, "discounted_cash": 3115.0, "minimum": 2268.093, "maximum": 7560.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SYNCOPE AND COLLAPSE", "code_information": [ { "code": "312", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7676.0, "minimum": 6030.55, "maximum": 22025.0067, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7408.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15749.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7408.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7408.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13550.75 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7676.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6030.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7676.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13550.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7408.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7676.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7408.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9693.66 } ] } ] }, { "description": "HC LARYNGOSCOPY DIRECT DIAGNOSTIC", "code_information": [ { "code": "31525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1146.56, "discounted_cash": 1756.0, "minimum": 343.968, "maximum": 1146.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1146.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fondaparinux Sodium Subcutaneous Inj 2.5 MG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55111067802", "type": "NDC" }, { "code": "J1652", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.849, "maximum": 1.849, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.85 } ] } ] }, { "description": "HC INCISION LINGUAL FRENUM FRENOTOMY", "code_information": [ { "code": "41010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3409.38, "discounted_cash": 1530.0, "minimum": 1022.814, "maximum": 3409.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3409.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3409.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3409.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2589.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L2624) HIP ADJ FLEX EXT ABDUCT CONT", "code_information": [ { "code": "L2624", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 380.0, "minimum": 369.7893, "maximum": 643.5354, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 380.52, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 462.22, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 369.79, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 380.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 380.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 380.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 380.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 380.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 643.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY GALLBLADDER W ORAL CONTRAST", "code_information": [ { "code": "74290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 850.63, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 828.2611, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 614.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON", "code_information": [ { "code": "93285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.56, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 197.5603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.88, "discounted_cash": 8.0, "minimum": 7.8521, "maximum": 88.8394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 61.6, "10th_percentile": 51.74, "90th_percentile": 61.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 51.92, "10th_percentile": 51.92, "90th_percentile": 51.92, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 54.83, "10th_percentile": 52.79, "90th_percentile": 105.58, "count": "15" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 36.12, "10th_percentile": 36.12, "90th_percentile": 61.6, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 67.76, "10th_percentile": 67.76, "90th_percentile": 71.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY FOR PHENCYCLIDINE", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "discounted_cash": 20.0, "minimum": 20.0, "maximum": 174.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.71, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 76.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13444.0, "minimum": 10505.19, "maximum": 46360.231, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29452.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28391.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13444.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10505.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13444.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28391.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13444.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12942.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18127.23 } ] } ] }, { "description": "Ondansetron HCl Inj 4 MG/2ML (2 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "60505613000", "type": "NDC" }, { "code": "J2405", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 14.27, "count": "57" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 25.42, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 0.72, "10th_percentile": 0.72, "90th_percentile": 0.72, "count": "1 through 10" } ] } ] }, { "description": "HC HEPATITIS B AG, EIA", "code_information": [ { "code": "87350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.56, "discounted_cash": 11.0, "minimum": 11.2049, "maximum": 119.0803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 69.22, "10th_percentile": 69.22, "90th_percentile": 69.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 70.62, "10th_percentile": 70.62, "90th_percentile": 70.62, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 60.5, "10th_percentile": 60.5, "90th_percentile": 95.27, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EEG,W/AWAKE & ASLEEP RECORD", "code_information": [ { "code": "95819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2220.31, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1936.1103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1548.89, "10th_percentile": 1548.89, "90th_percentile": 1548.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7525) TRACHEOSTOMY MASK - A7525 - 27100101", "code_information": [ { "code": "A7525", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.8571, "maximum": 4.9721, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.57, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.86, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Deferoxamine Mesylate For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323059710", "type": "NDC" }, { "code": "J0895", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.6515, "maximum": 17.6515, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.65 } ] } ] }, { "description": "HC CT ANGIO, PELVIS, COMBO, INCL IMAGE PROC", "code_information": [ { "code": "72191", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2282.19, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2006.5997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2006.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1592.05, "10th_percentile": 1592.05, "90th_percentile": 1592.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1747) ENDO, SINGLE, URINARY TRACT", "code_information": [ { "code": "C1747", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 4589.26, "10th_percentile": 2002.56, "90th_percentile": 4589.26, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 5309.06, "10th_percentile": 5309.06, "90th_percentile": 5309.06, "count": "1 through 10" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC", "code_information": [ { "code": "086", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10955.0, "minimum": 9078.02, "maximum": 23539.5806, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10554.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23539.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10554.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10554.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21657.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10955.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9078.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10955.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21657.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10554.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10955.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10554.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14488.21 } ] } ] }, { "description": "HC IRRADIATION BLOOD PRODUCT, PER UNIT", "code_information": [ { "code": "86945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.56, "discounted_cash": 36.0, "minimum": 36.85, "maximum": 171.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 171.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.09, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CHROMIUM", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.13, "discounted_cash": 20.0, "minimum": 19.7081, "maximum": 116.0894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Heparin Sodium (Porcine) Inj 5000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409272330", "type": "NDC" }, { "code": "J1644", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 14.48, "10th_percentile": 11.99, "90th_percentile": 68.71, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 16.2, "count": "1 through 10" } ] } ] }, { "description": "HC STRAPPING HAND OR FINGER", "code_information": [ { "code": "29280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.69, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 278.7697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Insulin Lispro Soln Pen-injector 100 Unit/ML (1 Unit Dial) - 00002822201 - 25000001", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00002822201", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC HEMOPHILUS INFLUENZA ANTIBDY", "code_information": [ { "code": "86684", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 306.88, "discounted_cash": 15.0, "minimum": 15.3933, "maximum": 267.5994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLOTTING FUNCT ACTIVITY", "code_information": [ { "code": "85397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 757.81, "discounted_cash": 30.0, "minimum": 29.9897, "maximum": 660.8103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.49, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.99, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.93 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND SMP FACE 5.1-7.5 CM", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 452.19, "discounted_cash": 197.0, "minimum": 135.657, "maximum": 452.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 452.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 452.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 452.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SEIZURES WITHOUT MCC", "code_information": [ { "code": "101", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7912.0, "minimum": 6379.39, "maximum": 17019.4206, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7634.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16309.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7634.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 14886.14, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13475.13, "10th_percentile": 13475.13, "90th_percentile": 13475.13, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7634.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14628.19 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7912.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6379.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7912.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14628.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7634.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7912.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7634.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10038.43 } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "185", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7029.0, "minimum": 5382.72, "maximum": 17449.5185, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14211.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17030.5 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7029.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5382.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7029.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17030.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7029.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8747.2 } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7308.0, "minimum": 3610.4521, "maximum": 32983.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7055.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14875.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7055.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7055.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32983.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7308.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5933.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7308.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32983.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7055.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7308.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7055.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9155.37 } ] } ] }, { "description": "HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1950.31, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1700.6703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 959.28, "10th_percentile": 270.03, "90th_percentile": 1142.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1109.74, "10th_percentile": 1109.74, "90th_percentile": 1154.16, "count": "24" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 605.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 270.26, "10th_percentile": 270.26, "90th_percentile": 270.26, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1256.2, "10th_percentile": 1256.2, "90th_percentile": 1319.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Triamcinolone Acetonide Inj Susp 40 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "70121104901", "type": "NDC" }, { "code": "J3301", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.8705, "maximum": 1.8705, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.87 } ] } ] }, { "description": "HC CT ORBIT/SELLA/POST FOSSA/EAR W CONTR", "code_information": [ { "code": "70481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2255.63, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1966.9094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1161.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1573.52, "10th_percentile": 1573.52, "90th_percentile": 1573.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RBC LEUKOREDUCED IRRADIATED, PER UNIT", "code_information": [ { "code": "P9040", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 993.44, "discounted_cash": 264.0, "minimum": 264.11, "maximum": 993.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 716.24, "10th_percentile": 358.12, "90th_percentile": 1247.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 993.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 993.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 993.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 287.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 446.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine HCl Inj 50 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323066400", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.419, "maximum": 1.419, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 14.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.42 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 14.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1.32, "10th_percentile": 1.32, "90th_percentile": 1.32, "count": "1 through 10" } ] } ] }, { "description": "HC VASCULAR BIOPSY", "code_information": [ { "code": "75970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3505.63, "minimum": 1051.689, "maximum": 3281.8973, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3281.9 } ] } ] }, { "description": "HC BORRELIA ANTIBODY", "code_information": [ { "code": "86619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.5, "discounted_cash": 13.0, "minimum": 13.0027, "maximum": 241.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.0, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX SCAN EXTRACRANIAL,BILAT", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1845.63, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1609.3894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 992.21, "10th_percentile": 992.21, "90th_percentile": 992.21, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 433.5, "10th_percentile": 426.0, "90th_percentile": 522.22, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITH CC", "code_information": [ { "code": "797", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8656.0, "minimum": 6701.23, "maximum": 24650.1625, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18077.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8348.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 21628.26, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 20773.27, "10th_percentile": 20773.27, "90th_percentile": 20773.27, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8348.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21634.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8656.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6701.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8656.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21634.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8348.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8656.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8348.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11126.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8348.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH", "code_information": [ { "code": "92920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18444.4, "discounted_cash": 5615.0, "minimum": 5533.32, "maximum": 18444.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18444.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18444.4, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18444.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRUG ASSAY VORICONAZOLE", "code_information": [ { "code": "80285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.0, "discounted_cash": 27.0, "minimum": 26.3455, "maximum": 261.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.93, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COLLECT BLD ESTABLISHED CATH", "code_information": [ { "code": "36592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.38, "discounted_cash": 131.0, "minimum": 11.814, "maximum": 39.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 20.16, "10th_percentile": 20.16, "90th_percentile": 20.16, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 26.4, "10th_percentile": 26.4, "90th_percentile": 26.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MR SAFETY DETERMINATION PHYSICIAN/OTHER QHP", "code_information": [ { "code": "76016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.31, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 330.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 330.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 330.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 330.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLACE INTERST RAD THER GUIDE, INTRAABD/INTRAPELV/RETROPER,1+,PERC", "code_information": [ { "code": "49411", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5331.56, "discounted_cash": 1365.0, "minimum": 1365.72, "maximum": 5331.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5331.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5331.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5228.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1365.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1365.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1488.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1365.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1365.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1365.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2309.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TIBIA SHAFT FX W MANIP", "code_information": [ { "code": "27752", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10065.9, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 8777.4648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6250.61, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7593.04, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6074.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROTHROMBIN TIME", "code_information": [ { "code": "85610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.69, "discounted_cash": 4.0, "minimum": 4.169, "maximum": 86.9297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 60.2, "10th_percentile": 50.57, "90th_percentile": 60.2, "count": "25" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 50.8, "10th_percentile": 47.93, "90th_percentile": 50.8, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 53.65, "10th_percentile": 51.59, "90th_percentile": 53.65, "count": "37" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 19.18, "10th_percentile": 19.18, "90th_percentile": 19.18, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 66.22, "10th_percentile": 22.44, "90th_percentile": 69.54, "count": "92" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17328.0, "minimum": 14170.73, "maximum": 75443.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16670.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38682.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16670.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16670.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 75443.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17328.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14170.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17328.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75443.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16670.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17328.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16670.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23808.18 } ] } ] }, { "description": "HC ORTHOPOXVIRUS AMP PRB EACH", "code_information": [ { "code": "87593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.0, "discounted_cash": 51.0, "minimum": 49.8631, "maximum": 170.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.33, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.86, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY HUMERUS", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 517.19, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 450.9897, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 315.57, "10th_percentile": 315.57, "90th_percentile": 315.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 360.79, "10th_percentile": 343.42, "90th_percentile": 686.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 262.25, "10th_percentile": 262.25, "90th_percentile": 262.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY ANKLE 2 VW", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 389.69, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 389.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 197.57, "10th_percentile": 197.57, "90th_percentile": 197.57, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 389.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 228.56, "10th_percentile": 228.56, "90th_percentile": 228.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 258.72, "10th_percentile": 258.72, "90th_percentile": 258.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Potassium Chloride Inj 20 mEq/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338070341", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ASSAY OF ARSENIC", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.19, "discounted_cash": 18.0, "minimum": 15.657, "maximum": 52.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 41.75, "10th_percentile": 41.75, "90th_percentile": 41.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 28.62, "10th_percentile": 28.62, "90th_percentile": 28.62, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 36.74, "10th_percentile": 36.74, "90th_percentile": 36.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPLACE CV CATH CMPLT NONTUNNLD WO SUBQ PORT/PUMP", "code_information": [ { "code": "36580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4628.75, "discounted_cash": 1553.0, "minimum": 1388.625, "maximum": 4628.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4628.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4628.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4628.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHANGE CYSTOSTOMY TUBE COMPLICATED", "code_information": [ { "code": "51710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10736.6, "discounted_cash": 688.0, "minimum": 688.02, "maximum": 9362.3152, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2710.52, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3292.66, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2634.22, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 749.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1163.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS", "code_information": [ { "code": "45300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 514.06, "discounted_cash": 917.0, "minimum": 154.218, "maximum": 514.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 514.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITH CC", "code_information": [ { "code": "669", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12851.0, "minimum": 10710.76, "maximum": 57307.965, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28044.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33564.17 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10710.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33564.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12851.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17260.85 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CCMCC", "code_information": [ { "code": "087", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8004.0, "minimum": 6118.46, "maximum": 17881.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7723.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16528.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7723.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7723.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17881.92 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8004.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6118.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8004.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17881.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7723.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8004.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7723.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10173.0 } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC", "code_information": [ { "code": "061", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22016.0, "minimum": 18711.12, "maximum": 50278.5739, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21168.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 49820.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21168.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21168.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39835.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22016.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18711.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22016.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39835.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21168.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22016.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21168.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30663.58 } ] } ] }, { "description": "HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS", "code_information": [ { "code": "36466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7225.63, "discounted_cash": 2035.0, "minimum": 2035.84, "maximum": 7225.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7225.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7225.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7225.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4137) AMNIOEXCEL OR BIODEXCEL", "code_information": [ { "code": "Q4137", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IQ TSTS ALLERGENIC XTRCS DLYD TYP RXN W/READING", "code_information": [ { "code": "95028", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.31, "discounted_cash": 36.0, "minimum": 27.093, "maximum": 90.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 90.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.69, "discounted_cash": 9.0, "minimum": 9.0377, "maximum": 108.7297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 97.4, "10th_percentile": 81.82, "90th_percentile": 178.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 64.66, "10th_percentile": 64.66, "90th_percentile": 64.66, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 83.47, "10th_percentile": 69.59, "90th_percentile": 153.06, "count": "34" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 106.17, "10th_percentile": 18.6, "90th_percentile": 300.84, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.73, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 468.13, "discounted_cash": 17.0, "minimum": 16.783, "maximum": 408.2094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 251.66, "10th_percentile": 251.66, "90th_percentile": 274.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 256.76, "10th_percentile": 133.69, "90th_percentile": 280.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 77.2, "10th_percentile": 77.2, "90th_percentile": 77.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 300.25, "10th_percentile": 90.62, "90th_percentile": 329.56, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4648) IMPLANTABLE TISSUE MARKER - A4648 - 27800080", "code_information": [ { "code": "A4648", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 88.87, "10th_percentile": 88.87, "90th_percentile": 1799.0, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 265.99, "10th_percentile": 253.43, "90th_percentile": 265.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 267.35, "10th_percentile": 267.35, "90th_percentile": 1723.89, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 516.38, "10th_percentile": 516.38, "90th_percentile": 516.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 304.11, "10th_percentile": 249.91, "90th_percentile": 2098.25, "count": "1 through 10" } ] } ] }, { "description": "HC CLSD TREAT DIST FINGR FX W MANIP EA", "code_information": [ { "code": "26755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 516.88, "discounted_cash": 243.0, "minimum": 155.064, "maximum": 516.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 516.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 516.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 516.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD NECK/HND/FT/GENT 2.6-7.5 CM", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT PRPH CTR VAD W/SUBQ PORT < 5YR", "code_information": [ { "code": "36570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6275.0, "discounted_cash": 3115.0, "minimum": 1882.5, "maximum": 6275.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6275.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6275.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6275.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITH MCC", "code_information": [ { "code": "907", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30247.0, "minimum": 27572.5, "maximum": 74889.7632, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 69375.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 29066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 65708.9, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 81401.09, "10th_percentile": 81401.09, "90th_percentile": 81401.09, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 29066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 73581.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 30247.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27572.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30247.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 73581.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 30247.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29066.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42699.47 } ] } ] }, { "description": "HC DOPPLER COLOR FLOW VELOCITY MAP (93325)", "code_information": [ { "code": "93325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 665.63, "minimum": 199.689, "maximum": 580.4294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 357.84, "10th_percentile": 357.84, "90th_percentile": 357.84, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 406.3, "10th_percentile": 406.3, "90th_percentile": 406.3, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 413.97, "10th_percentile": 406.14, "90th_percentile": 413.97, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 408.21, "10th_percentile": 408.21, "90th_percentile": 408.21, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 114.41, "10th_percentile": 114.41, "90th_percentile": 114.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 464.34, "10th_percentile": 464.34, "90th_percentile": 928.68, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6253) ABSORPT DRG > 48 SQ IN W/O B - A6253 - 27200142", "code_information": [ { "code": "A6253", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 8.7754, "maximum": 15.2715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4595) TENS SUPPL 2 LEAD PER MONTH", "code_information": [ { "code": "A4595", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 12.0, "minimum": 12.5848, "maximum": 21.901, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.73, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28565.0, "minimum": 24689.77, "maximum": 78249.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 65380.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 78249.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28565.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24689.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28565.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78249.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28565.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27452.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40240.46 } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITHOUT CCMCC", "code_information": [ { "code": "198", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6495.0, "minimum": 4658.06, "maximum": 15489.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12941.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15489.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6495.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4658.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6495.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15489.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6495.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7965.35 } ] } ] }, { "description": "HC STANDARDIZED COGNITIVE PERFORMANCE TESTING", "code_information": [ { "code": "96125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.31, "discounted_cash": 98.0, "minimum": 90.093, "maximum": 261.8703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 98.79, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 98.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 98.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 167.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<", "code_information": [ { "code": "15240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7309.69, "discounted_cash": 2035.0, "minimum": 2035.84, "maximum": 7309.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7309.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7309.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7309.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1732) CATH, EP, DIAG/ABL, 3D/VECT", "code_information": [ { "code": "C1732", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 5072.59, "10th_percentile": 5072.59, "90th_percentile": 5072.59, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6214) FOAM DRG > 48 SQ IN W/BORDER", "code_information": [ { "code": "A6214", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 14.0, "minimum": 14.266, "maximum": 24.8268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 481.25, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 481.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 244.1, "10th_percentile": 244.1, "90th_percentile": 290.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 481.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 481.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 481.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 356.26, "10th_percentile": 351.7, "90th_percentile": 363.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 385.0, "10th_percentile": 385.0, "90th_percentile": 385.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTRALUMINAL DILATION W IMG", "code_information": [ { "code": "74360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1251.25, "minimum": 375.375, "maximum": 1091.09, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.02 } ] } ] }, { "description": "HC (SUP SHELL C2645) BRACHYTX PLANAR, P-103", "code_information": [ { "code": "C2645", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.67, "maximum": 22.3492, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SPINAL PUNCTURE,THERAPEUTIC DRAINAGE", "code_information": [ { "code": "62272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1323.75, "discounted_cash": 696.0, "minimum": 397.125, "maximum": 1323.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1323.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1323.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1323.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "272", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20464.0, "minimum": 17318.55, "maximum": 60182.0915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19679.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 46132.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19679.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19679.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47794.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20464.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17318.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20464.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47794.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19679.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20464.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19679.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28393.65 } ] } ] }, { "description": "HC SPLEEN IMAGING", "code_information": [ { "code": "78185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 788.13, "discounted_cash": 394.0, "minimum": 236.439, "maximum": 788.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 788.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 788.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 788.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI LOWER EXTR W/O CONTRAST F/U BY CONTRAST", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3281.25, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2861.25, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2161.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 193.0, "10th_percentile": 193.0, "90th_percentile": 1571.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" } ] } ] }, { "description": "HC FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION", "code_information": [ { "code": "10009", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3806.25, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 3343.8164, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3343.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4206) FLUID FLOW OR FLUID GF 1 CC", "code_information": [ { "code": "Q4206", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5263.2, "maximum": 5263.2, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5263.2 } ] } ] }, { "description": "HC CT SCAN HEAD CONTRAST", "code_information": [ { "code": "70460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2340.31, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2040.7503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 868.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT", "code_information": [ { "code": "37243", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34679.1, "discounted_cash": 11390.0, "minimum": 10403.73, "maximum": 34679.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34679.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34679.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34679.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SARS-COV-2 COVID19 W/OPTIC", "code_information": [ { "code": "87811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.5, "discounted_cash": 41.0, "minimum": 18.75, "maximum": 62.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.21, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 33.64, "10th_percentile": 33.64, "90th_percentile": 33.64, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 41.58, "10th_percentile": 41.58, "90th_percentile": 41.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MR ANGIO, NECK, COMBO", "code_information": [ { "code": "70549", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3072.5, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2679.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2381.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "25021010010", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7845, "maximum": 1.7845, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.87, "10th_percentile": 11.99, "90th_percentile": 26.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.78 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8332.0, "minimum": 6045.78, "maximum": 23568.3333, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 21216.91, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5369.37, "10th_percentile": 5369.37, "90th_percentile": 18799.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17307.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15201.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8332.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6045.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8332.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15201.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 23568.33, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 25235.44, "10th_percentile": 25235.44, "90th_percentile": 25235.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8332.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10652.35 } ] } ] }, { "description": "HC CYP2C9 GENE ANALYSIS COMMON VARIANTS", "code_information": [ { "code": "81227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 784.38, "discounted_cash": 174.0, "minimum": 169.8804, "maximum": 784.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 174.81, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 212.34, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 169.88, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 784.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 295.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Desmopressin Acetate Inj 4 MCG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "43598093111", "type": "NDC" }, { "code": "J2597", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.6535, "maximum": 9.6535, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.65 } ] } ] }, { "description": "HC MRI, FACE, NECK, COMBO", "code_information": [ { "code": "70543", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3309.69, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2886.0497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2176.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Alteplase For Inj 2 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50242004164", "type": "NDC" }, { "code": "J2997", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 95.0, "minimum": 91.7865, "maximum": 374.6166, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.62, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.73, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.79, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 95.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 95.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 95.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED PX HANDS/FINGERS", "code_information": [ { "code": "26989", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 828.75, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 828.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 828.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 828.75, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "HC MYCOPLASMA CULTURE", "code_information": [ { "code": "87109", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 307.81, "discounted_cash": 15.0, "minimum": 14.956, "maximum": 268.4103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.69, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 68.79, "10th_percentile": 68.79, "90th_percentile": 68.79, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 214.73, "10th_percentile": 214.73, "90th_percentile": 214.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN MAXILLOFACIAL AREA W CONTRAST", "code_information": [ { "code": "70487", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1978.44, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1725.1997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1207.16, "10th_percentile": 1207.16, "90th_percentile": 1207.16, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 400.56, "10th_percentile": 400.56, "90th_percentile": 400.56, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT", "code_information": [ { "code": "34702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15376.9, "minimum": 4613.07, "maximum": 15376.9, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15376.9 } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC", "code_information": [ { "code": "436", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9650.0, "minimum": 7805.18, "maximum": 48135.5118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9302.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20438.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9302.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9302.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20007.58 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9650.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7805.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9650.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20007.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9302.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9650.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9302.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12579.73 } ] } ] }, { "description": "HC INSERT TUNNELED CV CATH WITH PUMP", "code_information": [ { "code": "36563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7702.81, "discounted_cash": 5490.0, "minimum": 2310.843, "maximum": 7702.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7702.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7702.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7702.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7702.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERCUT TRANSHEPAT DILAT,BILE DUCT STRICT", "code_information": [ { "code": "74363", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2185.0, "minimum": 655.5, "maximum": 1905.32, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 664.0 } ] } ] }, { "description": "HC PHYS THRP EVAL, LOW COMPLEXITY, 20 MIN", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.94, "discounted_cash": 94.0, "minimum": 91.3978, "maximum": 458.6197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 282.74, "10th_percentile": 282.74, "90th_percentile": 282.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.05, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.4, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 320.91, "10th_percentile": 320.91, "90th_percentile": 320.91, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 322.55, "10th_percentile": 322.55, "90th_percentile": 322.55, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 94.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 333.23, "10th_percentile": 333.23, "90th_percentile": 333.23, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 94.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 366.89, "10th_percentile": 322.55, "90th_percentile": 370.26, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 94.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EEG,EXTENDED MONITORING,41-60 MINUTES", "code_information": [ { "code": "95812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1107.81, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1019.5934, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME", "code_information": [ { "code": "20950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2777.19, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 2777.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2777.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC", "code_information": [ { "code": "558", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7841.0, "minimum": 5978.64, "maximum": 16139.9811, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7566.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16139.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7566.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7566.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9149.43 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7841.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5978.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7841.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9149.43 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 15405.1, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9444.36, "10th_percentile": 9444.36, "90th_percentile": 9444.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7566.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7841.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7566.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9933.88 } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46250.0, "minimum": 14598.97, "maximum": 107398.094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 44990.62, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7238.29, "10th_percentile": 7238.29, "90th_percentile": 7238.29, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44422.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 107398.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 44422.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 44422.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14598.97 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 46250.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41145.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46250.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14599.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 44422.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 46250.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44422.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66101.71 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505614800", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0535, "maximum": 1.0535, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 15.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.84, "90th_percentile": 14.84, "count": "1 through 10" } ] } ] }, { "description": "HC REPR WND SMP FACE 2.6-5.0 CM", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 497.5, "discounted_cash": 197.0, "minimum": 149.25, "maximum": 497.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 497.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8001) BREAST PROSTHESIS BRA & FORM", "code_information": [ { "code": "L8001", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 150.0, "minimum": 146.5183, "maximum": 254.9822, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 150.77, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 183.14, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 146.52, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 150.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 150.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 150.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 150.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 254.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2554.69, "discounted_cash": 894.0, "minimum": 766.407, "maximum": 2554.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2554.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2554.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2554.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ALPHA-FETOPROTEIN, SERUM", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.31, "discounted_cash": 16.0, "minimum": 16.2971, "maximum": 240.0703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 38.81, "10th_percentile": 38.81, "90th_percentile": 148.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 36.79, "10th_percentile": 36.79, "90th_percentile": 140.3, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 148.16, "10th_percentile": 38.85, "90th_percentile": 151.0, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 57.75, "10th_percentile": 41.89, "90th_percentile": 74.96, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 50.82, "10th_percentile": 50.36, "90th_percentile": 193.82, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHORIONIC GONADOTROPIN, QUAL", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.13, "discounted_cash": 7.0, "minimum": 7.3079, "maximum": 103.0094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 75.6, "10th_percentile": 33.61, "90th_percentile": 75.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 60.2, "10th_percentile": 60.2, "90th_percentile": 60.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 64.79, "10th_percentile": 63.57, "90th_percentile": 64.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 33.61, "10th_percentile": 33.61, "90th_percentile": 33.61, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 83.16, "10th_percentile": 39.46, "90th_percentile": 83.16, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3", "code_information": [ { "code": "86300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.69, "discounted_cash": 20.0, "minimum": 20.2232, "maximum": 134.8897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 78.83, "10th_percentile": 74.37, "90th_percentile": 78.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 102.74, "10th_percentile": 20.81, "90th_percentile": 107.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT MID HUMERUS FX W MANIP", "code_information": [ { "code": "24505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1081.88, "discounted_cash": 1586.0, "minimum": 324.564, "maximum": 1081.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1081.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Potassium Chloride Inj 2 mEq/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323096502", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ASSAY QUANTITATIVE,BLOOD GLUCOSE", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.13, "discounted_cash": 3.0, "minimum": 3.8192, "maximum": 72.4894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 44.4, "10th_percentile": 37.3, "90th_percentile": 44.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 35.35, "10th_percentile": 35.35, "90th_percentile": 35.35, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 38.05, "10th_percentile": 37.33, "90th_percentile": 44.73, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.57, "10th_percentile": 17.57, "90th_percentile": 17.57, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 48.4, "10th_percentile": 20.62, "90th_percentile": 48.84, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF COPPER", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.25, "discounted_cash": 12.0, "minimum": 12.06, "maximum": 118.81, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 95.92, "10th_percentile": 95.05, "90th_percentile": 95.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 73.25, "10th_percentile": 73.25, "90th_percentile": 73.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 73.32, "10th_percentile": 73.32, "90th_percentile": 229.5, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 55.47, "10th_percentile": 55.47, "90th_percentile": 55.47, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4021) CAST SUP SHT ARM SPLINT PLST", "code_information": [ { "code": "Q4021", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.3478, "maximum": 14.5274, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.43, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE CHLORIDE", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.75, "discounted_cash": 5.0, "minimum": 5.5879, "maximum": 77.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NONTRAUMATIC STUPOR AND COMA WITH MCC", "code_information": [ { "code": "080", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14813.0, "minimum": 13628.1, "maximum": 46671.4238, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14256.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32706.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14256.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14256.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21414.28 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14813.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13628.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14813.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21414.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14256.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14813.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14256.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20130.24 } ] } ] }, { "description": "Albumin, Human Inj 25%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "68516521601", "type": "NDC" }, { "code": "P9047", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 53.0, "minimum": 51.5831, "maximum": 209.1021, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 209.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.48, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBODY TREPONEMA PALLIDUM", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.19, "discounted_cash": 13.0, "minimum": 12.8666, "maximum": 237.3497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED MR PROCEDURE", "code_information": [ { "code": "76498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2223.75, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 1939.11, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NON-EXTENSIVE BURNS", "code_information": [ { "code": "935", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16715.0, "minimum": 15202.01, "maximum": 37223.8704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16081.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37223.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16081.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16081.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31615.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16715.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15202.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16715.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31615.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16081.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16715.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16081.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22910.66 } ] } ] }, { "description": "HC DRAINAGE OF NOSE LESION", "code_information": [ { "code": "30000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1764.06, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 1538.2603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1118.42, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 894.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIALYSIS OTHER THAN HEMO W SING EVAL (CAPD)", "code_information": [ { "code": "90945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1566.88, "discounted_cash": 411.0, "minimum": 411.71, "maximum": 1566.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1566.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1566.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1566.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 448.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VIP", "code_information": [ { "code": "84586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 674.38, "discounted_cash": 35.0, "minimum": 34.3337, "maximum": 588.0594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 157.93, "10th_percentile": 157.93, "90th_percentile": 157.93, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.92, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 185.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Labetalol HCl IV Soln 5 MG/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "72266010201", "type": "NDC" }, { "code": "J1920", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC REVSC EVASC FPVT ATHRC UNI CPLX LES 1ST VSL", "code_information": [ { "code": "37273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR MOUTH LACERATION,>2.5 CM", "code_information": [ { "code": "40831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4016.56, "discounted_cash": 532.0, "minimum": 532.15, "maximum": 3502.4403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2096.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2546.71, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2037.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 580.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 899.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "827", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18625.0, "minimum": 16333.65, "maximum": 47792.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17914.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 41763.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17914.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17914.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47792.95 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18625.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16333.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18625.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47792.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17914.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18625.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17914.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25704.43 } ] } ] }, { "description": "HC OVA AND PARASITES SMEARS", "code_information": [ { "code": "87177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.81, "discounted_cash": 8.0, "minimum": 8.649, "maximum": 155.0503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 107.4, "10th_percentile": 107.4, "90th_percentile": 107.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 85.52, "10th_percentile": 85.52, "90th_percentile": 85.52, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 92.04, "10th_percentile": 92.04, "90th_percentile": 95.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 39.78, "10th_percentile": 39.78, "90th_percentile": 39.78, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 46.7, "10th_percentile": 46.55, "90th_percentile": 118.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US,PREGNANT UTERUS,LIMITED, 1/> FETUSES", "code_information": [ { "code": "76815", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 591.0503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 197.62, "10th_percentile": 197.62, "90th_percentile": 197.62, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 323.5, "10th_percentile": 323.5, "90th_percentile": 323.5, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 444.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 449.02, "10th_percentile": 449.02, "90th_percentile": 471.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409733811", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0535, "maximum": 1.0535, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 15.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.84, "90th_percentile": 14.84, "count": "1 through 10" } ] } ] }, { "description": "Levetiracetam Inj 500 MG/5ML (100 MG/ML)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00409188622", "type": "NDC" }, { "code": "J1953", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 183.06, "10th_percentile": 183.06, "90th_percentile": 290.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC INJ DX/THER SBST INTRLMNR LMBR/SAC W IMG", "code_information": [ { "code": "62323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3506.56, "discounted_cash": 696.0, "minimum": 696.49, "maximum": 3333.1922, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1849.59, "10th_percentile": 1849.59, "90th_percentile": 1849.59, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MAMMOGRAPHY; UNILATERAL", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.88, "discounted_cash": 79.0, "minimum": 76.9471, "maximum": 501.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 321.2, "10th_percentile": 297.0, "90th_percentile": 321.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 79.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.18, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 76.95, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 254.55, "10th_percentile": 254.55, "90th_percentile": 254.55, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 306.22, "10th_percentile": 283.15, "90th_percentile": 312.13, "count": "23" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 79.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 346.43, "10th_percentile": 113.95, "90th_percentile": 355.54, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 79.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 79.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 326.7, "10th_percentile": 307.79, "90th_percentile": 353.32, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 79.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD PH", "code_information": [ { "code": "82800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.69, "discounted_cash": 11.0, "minimum": 10.6898, "maximum": 108.7297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 57.72, "10th_percentile": 57.72, "90th_percentile": 57.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITH MCC", "code_information": [ { "code": "031", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35123.0, "minimum": 29004.53, "maximum": 80961.9181, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33745.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 80961.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 33745.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33745.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 62206.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35123.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29004.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35123.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62206.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33745.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 35123.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33745.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49830.69 } ] } ] }, { "description": "HC MYCOBACT CULTURE,ISOLATN", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.75, "discounted_cash": 10.0, "minimum": 10.4954, "maximum": 199.47, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 48.28, "10th_percentile": 48.28, "90th_percentile": 48.28, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 123.1, "10th_percentile": 123.1, "90th_percentile": 123.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "818", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9864.0, "minimum": 6847.96, "maximum": 26983.5778, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20946.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22932.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9864.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6847.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9864.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22932.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9864.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12892.25 } ] } ] }, { "description": "HC FLUORESCENT ANTIBODY; SCREEN", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.06, "discounted_cash": 12.0, "minimum": 11.7102, "maximum": 221.5403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 153.4, "10th_percentile": 128.86, "90th_percentile": 153.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 252.09, "10th_percentile": 252.09, "90th_percentile": 252.09, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 131.46, "10th_percentile": 131.46, "90th_percentile": 282.2, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 53.86, "10th_percentile": 53.86, "90th_percentile": 53.86, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 168.74, "10th_percentile": 63.23, "90th_percentile": 177.23, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "330", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19279.0, "minimum": 16359.95, "maximum": 62758.1865, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 56496.76, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 31128.29, "10th_percentile": 31128.29, "90th_percentile": 41382.83, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18542.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 43317.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18542.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 54891.82, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 41508.97, "10th_percentile": 41508.97, "90th_percentile": 41508.97, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 55064.55, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 32505.27, "10th_percentile": 32505.27, "90th_percentile": 32505.27, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18542.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48361.86 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 62614.25, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 74873.86, "10th_percentile": 74873.86, "90th_percentile": 74873.86, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19279.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16359.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19279.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48361.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18542.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19279.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18542.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26660.89 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19745.0, "minimum": 16945.49, "maximum": 64004.1381, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44424.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 55981.6, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 32137.07, "10th_percentile": 32137.07, "90th_percentile": 32137.07, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37684.92 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 63857.34, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 44383.24, "10th_percentile": 44383.24, "90th_percentile": 44383.24, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19745.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16945.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19745.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37684.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19745.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18989.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27342.65 } ] } ] }, { "description": "Eptifibatide IV Soln 75 MG/100ML (0.75 MG/ML)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "67457063110", "type": "NDC" }, { "code": "J1327", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.261, "maximum": 23.306, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.85, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT/PLACE FLOW DIRECT CATH", "code_information": [ { "code": "93503", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5693.75, "discounted_cash": 1553.0, "minimum": 1553.22, "maximum": 5693.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5693.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5693.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5693.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [ { "code": "228", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38674.0, "minimum": 34491.06, "maximum": 179306.1186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37152.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 89398.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 37152.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37152.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 111369.45 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 38674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34491.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 111369.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37152.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 38674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37152.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55023.4 } ] } ] }, { "description": "HC (SUP SHELL A4334) URINARY CATH LEG STRAP - A4334 - 27090019", "code_information": [ { "code": "A4334", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 6.8123, "maximum": 11.8553, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT", "code_information": [ { "code": "11982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1145.94, "discounted_cash": 440.0, "minimum": 343.782, "maximum": 1145.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1145.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1145.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1145.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 745.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OCCULT BLOOD STOOL", "code_information": [ { "code": "82270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.63, "discounted_cash": 4.0, "minimum": 4.2565, "maximum": 65.9494, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INCIS/DRAIN SHLDR ABSC/HEMA,DEEP", "code_information": [ { "code": "23030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8870.31, "discounted_cash": 2866.0, "minimum": 2661.093, "maximum": 8870.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8870.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8870.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8870.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4847.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT PULSE GENER DUAL CHMBR", "code_information": [ { "code": "33213", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35935.9, "discounted_cash": 10313.0, "minimum": 10313.01, "maximum": 35935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11241.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17441.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24694.0, "minimum": 21169.58, "maximum": 64714.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23738.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 56182.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23738.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23738.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 64714.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24694.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21169.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24694.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 64714.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23738.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24694.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23738.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34579.53 } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10096.0, "minimum": 7468.12, "maximum": 39325.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9730.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21497.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9730.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 34238.29, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 17354.54, "10th_percentile": 17354.54, "90th_percentile": 17354.54, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9730.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39325.43 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10096.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7468.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10096.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39325.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9730.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10096.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9730.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13231.46 } ] } ] }, { "description": "HC ASSAY OF PHENOBARBITAL", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.25, "discounted_cash": 15.0, "minimum": 14.8685, "maximum": 214.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR EXTEN TENDON,DISTAL INSERT,CLOSE", "code_information": [ { "code": "26432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6351.88, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 6351.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6250.61, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6351.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6074.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC", "code_information": [ { "code": "728", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7217.0, "minimum": 5655.42, "maximum": 20880.7271, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6967.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14658.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6967.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6967.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10723.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7217.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5655.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7217.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10723.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6967.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7217.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6967.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9021.91 } ] } ] }, { "description": "HC ASSAY OF ALDOSTERONE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 580.63, "discounted_cash": 40.0, "minimum": 39.6009, "maximum": 506.3094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 371.6, "10th_percentile": 371.6, "90th_percentile": 371.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.6, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 295.89, "10th_percentile": 295.89, "90th_percentile": 295.89, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 312.47, "10th_percentile": 312.47, "90th_percentile": 312.47, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 182.15, "10th_percentile": 182.15, "90th_percentile": 182.15, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 213.82, "10th_percentile": 213.82, "90th_percentile": 405.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RUBELLA", "code_information": [ { "code": "86762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.06, "discounted_cash": 14.0, "minimum": 13.9842, "maximum": 99.4603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 64.32, "10th_percentile": 64.32, "90th_percentile": 68.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 58.13, "10th_percentile": 54.78, "90th_percentile": 58.13, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 58.96, "10th_percentile": 58.96, "90th_percentile": 61.38, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 64.32, "10th_percentile": 64.32, "90th_percentile": 64.32, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 79.57, "10th_percentile": 75.51, "90th_percentile": 79.57, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND CPLX SCALP 2.6-7.5 CM", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1827.81, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 1827.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1827.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylprednisolone Tab 4 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904691461", "type": "NDC" }, { "code": "J7509", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CFTR GENE COM VARIANTS", "code_information": [ { "code": "81220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 850.63, "discounted_cash": 556.0, "minimum": 255.189, "maximum": 850.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 676.1, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 540.9, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 850.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 606.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 850.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21278.0, "minimum": 19821.3, "maximum": 52048.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20460.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 48065.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20460.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20460.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 52048.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21278.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19821.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21278.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52048.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20460.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21278.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20460.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29583.67 } ] } ] }, { "description": "HC MRI SPINAL CANAL THORACIC W/CONTRAST", "code_information": [ { "code": "72147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2563.13, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2235.0494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1731.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL FB MOUTH SIMPLE", "code_information": [ { "code": "40804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.63, "discounted_cash": 894.0, "minimum": 99.189, "maximum": 330.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ CATH DRN W IMG VISCERAL", "code_information": [ { "code": "49405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8025.0, "discounted_cash": 1629.0, "minimum": 1629.64, "maximum": 7798.9681, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6420.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7798.97, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6239.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRA ABDOMEN ANGIO - 74185 - 61800003", "code_information": [ { "code": "74185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3124.69, "minimum": 900.0, "maximum": 2724.7297, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2307.89 } ] } ] }, { "description": "HC PHENOTYPE DNA HIV W/CULTURE, FIRST 10 DRUGS", "code_information": [ { "code": "87903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3095.0, "discounted_cash": 488.0, "minimum": 474.8798, "maximum": 2698.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 593.58, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 474.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2564.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 532.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 826.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "093", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7104.0, "minimum": 5463.01, "maximum": 20865.3542, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6859.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14389.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6859.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6859.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15690.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5463.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15690.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6859.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6859.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8856.19 } ] } ] }, { "description": "HC ANGIO INTERN MAMMARY", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3134.38, "discounted_cash": 3115.0, "minimum": 940.314, "maximum": 3134.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3134.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3134.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3134.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 976.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3134.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3134.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC", "code_information": [ { "code": "868", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8889.0, "minimum": 7268.09, "maximum": 20571.0294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8572.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18631.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8572.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8572.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19612.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8889.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7268.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8889.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19612.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8572.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8889.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8572.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11467.56 } ] } ] }, { "description": "HC US, CHEST,REAL TIME", "code_information": [ { "code": "76604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 536.56, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 525.5, "10th_percentile": 525.5, "90th_percentile": 525.5, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 600.81, "10th_percentile": 600.81, "90th_percentile": 600.81, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C9359) IMPLNT,BON VOID FILLER-PUTTY", "code_information": [ { "code": "C9359", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 264.9875, "maximum": 264.9875, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 264.99 } ] } ] }, { "description": "HC GONADOTROPIN (FSH)", "code_information": [ { "code": "83001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.19, "discounted_cash": 18.0, "minimum": 18.056, "maximum": 232.9897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 171.0, "10th_percentile": 83.05, "90th_percentile": 171.0, "count": "15" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 136.16, "10th_percentile": 136.16, "90th_percentile": 136.16, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 143.79, "10th_percentile": 143.79, "90th_percentile": 146.55, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 43.14, "10th_percentile": 43.14, "90th_percentile": 83.05, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 186.39, "10th_percentile": 97.49, "90th_percentile": 188.1, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "857", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17334.0, "minimum": 15080.89, "maximum": 79321.4591, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16676.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38696.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16676.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16676.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32966.02 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15080.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32966.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16676.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16676.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23817.08 } ] } ] }, { "description": "HC (SUP SHELL C9360) SURGIMEND, NEONATAL", "code_information": [ { "code": "C9360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 46.569, "maximum": 46.569, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.57 } ] } ] }, { "description": "HC (SUP SHELL L0472) TLSO RIGID FRAME HYPEREX PRE", "code_information": [ { "code": "L0472", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 553.0, "minimum": 538.2023, "maximum": 936.6204, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 553.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 553.82, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 672.73, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 553.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 538.2, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 553.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 553.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 553.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 603.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 553.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 553.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 553.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 553.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 553.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 936.62, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Amiodarone HCl Inj 900 MG/18ML (50 MG/ML)", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "63323061601", "type": "NDC" }, { "code": "J0282", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Ziprasidone Mesylate For Inj 20 MG (Base Equivalent)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "43598084811", "type": "NDC" }, { "code": "J3486", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 11.137, "maximum": 11.137, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.14 } ] } ] }, { "description": "HC EGD W US EXAM ESPH/STOMACH/DUODEN/JEJUNUM", "code_information": [ { "code": "43259", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3668.75, "discounted_cash": 1893.0, "minimum": 1100.625, "maximum": 3668.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3668.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3668.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3668.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2063.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3202.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTITHROMBIN III TEST,ACTIV", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.56, "discounted_cash": 11.0, "minimum": 11.5158, "maximum": 310.9203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.52, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 678.44, "discounted_cash": 18.0, "minimum": 17.8811, "maximum": 591.5997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 139.2, "10th_percentile": 139.2, "90th_percentile": 139.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PHYS THRP EVAL, MODERATE COMPLEXITY, 30 MIN", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.94, "discounted_cash": 94.0, "minimum": 91.4075, "maximum": 458.6197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 282.74, "10th_percentile": 282.74, "90th_percentile": 282.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.25, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.41, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE", "code_information": [ { "code": "78699", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.19, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1752.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1553.98, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1752.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ THRMBC/NFS DIALYSIS CIRC IMG DX ANGRPH S&I", "code_information": [ { "code": "36904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22145.3, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 22145.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22124.32, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22145.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ACNE SURGERY OF SKIN ABSCESS", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.31, "discounted_cash": 197.0, "minimum": 112.593, "maximum": 375.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TEAM CONF W/O PAT BY HC PRO", "code_information": [ { "code": "99368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.25, "minimum": 49.875, "maximum": 144.97, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC (SUP SHELL A2011) SUPRA SDRM, PER SQ CM", "code_information": [ { "code": "A2011", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HC RELOCATE SKIN POCKET CARDIOVERTER DEFIB", "code_information": [ { "code": "33223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5832.19, "discounted_cash": 2035.0, "minimum": 1749.657, "maximum": 5832.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5832.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5832.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5832.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND SMP BODY/SCALP/EXTR <2.5 CM", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 431.56, "discounted_cash": 197.0, "minimum": 129.468, "maximum": 431.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 220.92, "10th_percentile": 220.92, "90th_percentile": 220.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 431.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 431.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 431.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 260.37, "10th_percentile": 260.37, "90th_percentile": 260.37, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECT TENDON SHEATH/LIGAMENT", "code_information": [ { "code": "20550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1364.38, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1364.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1193.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1364.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1159.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRUG SCREEN QUANT GABAPENTIN", "code_information": [ { "code": "80171", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.13, "discounted_cash": 21.0, "minimum": 21.0589, "maximum": 608.7694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.32, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A2008) THERAGENESIS, PER SQ CM", "code_information": [ { "code": "A2008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BIOPSY SALIVARY GLAND,NEEDLE", "code_information": [ { "code": "42400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1330.94, "discounted_cash": 698.0, "minimum": 399.282, "maximum": 1330.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1330.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1330.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1330.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "515", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25285.0, "minimum": 21403.52, "maximum": 90487.2394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24305.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57586.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24305.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24305.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 63578.45 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25285.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21403.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25285.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 63578.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24305.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25285.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24305.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35443.68 } ] } ] }, { "description": "HC SKIN FUNGI CULTURE", "code_information": [ { "code": "87101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.94, "discounted_cash": 7.0, "minimum": 7.4926, "maximum": 183.9397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 101.44, "10th_percentile": 101.44, "90th_percentile": 101.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NASAL ENDO DX, UNILATERAL OR BILATERAL", "code_information": [ { "code": "31231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.0, "discounted_cash": 196.0, "minimum": 81.0, "maximum": 270.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 270.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 270.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 270.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 270.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CCMCC", "code_information": [ { "code": "099", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11409.0, "minimum": 9643.49, "maximum": 70659.904, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10990.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24618.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10990.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10990.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32831.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9643.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32831.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10990.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10990.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15152.18 } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC", "code_information": [ { "code": "071", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8851.0, "minimum": 7294.39, "maximum": 31140.3864, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8851.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17252.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8535.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8851.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8535.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11410.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8535.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18539.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8535.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8535.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17252.61 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8851.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7294.39 } ] } ] }, { "description": "HC CLSD TREAT IP JNT DISLOC W MANIP WO ANES", "code_information": [ { "code": "26770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 427.19, "discounted_cash": 243.0, "minimum": 128.157, "maximum": 427.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 427.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 427.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 427.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4561) PESSARY RUBBER, ANY TYPE", "code_information": [ { "code": "A4561", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 28.0, "minimum": 27.6283, "maximum": 48.0808, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.53, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.63, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Folic Acid Inj 5 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323018410", "type": "NDC" }, { "code": "J1808", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "SPLENIC PROCEDURES WITH MCC", "code_information": [ { "code": "799", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35492.0, "minimum": 32909.54, "maximum": 97945.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 50530.97, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 36085.03, "10th_percentile": 36085.03, "90th_percentile": 64778.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34098.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 81836.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34098.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34098.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 97945.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35492.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32909.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35492.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 97945.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34098.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 35492.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34098.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50368.98 } ] } ] }, { "description": "Lidocaine HCl Local Preservative Free (PF) Inj 0.5%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00409427816", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.13, "90th_percentile": 25.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.7, "10th_percentile": 15.7, "90th_percentile": 15.7, "count": "1 through 10" } ] } ] }, { "description": "HC ONC PRST8 CA ALYS ALL PSA STRUCTURAL ISOFORMS", "code_information": [ { "code": "0359U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1015.63, "discounted_cash": 760.0, "minimum": 304.689, "maximum": 1015.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 760.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 923.17, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 738.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1015.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 828.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1015.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EVAL OF BRONCHOSPASM,PROLONGED", "code_information": [ { "code": "94070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1197.19, "discounted_cash": 368.0, "minimum": 359.157, "maximum": 1197.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 751.83, "10th_percentile": 751.83, "90th_percentile": 751.83, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1197.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1197.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1197.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 734.21, "10th_percentile": 734.21, "90th_percentile": 734.21, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 401.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33959.0, "minimum": 29480.71, "maximum": 140066.4562, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32628.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 78195.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 32628.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 32628.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 102410.95 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33959.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29480.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33959.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 102411.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32628.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 33959.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32628.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48127.96 } ] } ] }, { "description": "HC (SUP SHELL A7526) TRACHEOSTOMY TUBE COLLAR - A7526 - 27100031", "code_information": [ { "code": "A7526", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.6938, "maximum": 8.1685, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC XRAY FEMUR =>2 VW", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 431.25, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 218.74, "10th_percentile": 218.74, "90th_percentile": 218.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 46.09, "10th_percentile": 46.09, "90th_percentile": 46.09, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 263.13, "10th_percentile": 263.13, "90th_percentile": 263.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 286.44, "10th_percentile": 85.86, "90th_percentile": 300.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM THYROID IMAGING WITH VASCULAR FLOW", "code_information": [ { "code": "78013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 818.44, "discounted_cash": 394.0, "minimum": 245.532, "maximum": 818.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 818.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 818.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 818.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 818.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9110.0, "minimum": 7495.8, "maximum": 20675.5683, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8784.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9110.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8784.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11790.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8784.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19155.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8784.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8784.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18263.8 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9110.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7495.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9110.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18263.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 20675.57, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 25331.16, "10th_percentile": 25331.16, "90th_percentile": 25331.16, "count": "1 through 10" } ] } ] }, { "description": "HC ARC RBC PRETREAT,SERUM DIFF RBC ABSO", "code_information": [ { "code": "86978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "discounted_cash": 58.0, "minimum": 43.5, "maximum": 145.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 145.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7030) CPAP FULL FACE MASK", "code_information": [ { "code": "A7030", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 118.0, "minimum": 114.8085, "maximum": 199.7984, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.14, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.81, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 118.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 118.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 118.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 118.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 199.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0220) THOR RIB BELT CUSTOM FABRICA", "code_information": [ { "code": "L0220", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 152.0, "minimum": 148.5493, "maximum": 258.5168, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 152.86, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.68, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 148.55, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 152.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 152.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 152.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 258.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Voriconazole For Inj 200 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00049319028", "type": "NDC" }, { "code": "J3465", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.279, "maximum": 2.279, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.28 } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC", "code_information": [ { "code": "918", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7566.0, "minimum": 6122.61, "maximum": 29325.359, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7302.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15487.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7302.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 25649.6, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 27752.68, "10th_percentile": 27752.68, "90th_percentile": 27752.68, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7302.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11594.61 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7566.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6122.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7566.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11594.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7302.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7566.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7302.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9532.39 } ] } ] }, { "description": "HC ASSAY OF LIPASE", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.13, "discounted_cash": 6.0, "minimum": 6.6957, "maximum": 103.0094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 63.5, "10th_percentile": 63.5, "90th_percentile": 75.6, "count": "33" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 60.2, "10th_percentile": 60.2, "90th_percentile": 60.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 63.57, "10th_percentile": 63.57, "90th_percentile": 64.79, "count": "63" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 75.6, "count": "22" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 36.15, "10th_percentile": 36.15, "90th_percentile": 36.15, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS", "code_information": [ { "code": "49452", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2761.25, "discounted_cash": 894.0, "minimum": 828.375, "maximum": 2761.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2761.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2761.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2761.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI JOINT OF LEG. COMBO", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.94, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 3270.8197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2597.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RECTAL RESECTION WITH CC", "code_information": [ { "code": "333", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18861.0, "minimum": 14709.9, "maximum": 50294.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18140.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 42323.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18140.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18140.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 50294.62 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18861.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14709.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18861.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50294.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18140.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18861.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18140.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26049.2 } ] } ] }, { "description": "HC REVSC EVASC IVT ANGIO CPLX 1", "code_information": [ { "code": "37256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27547.8, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 26875.9169, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22124.32, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26875.92, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND SMP FACE >30.1 CM", "code_information": [ { "code": "12018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 710.94, "discounted_cash": 197.0, "minimum": 197.97, "maximum": 710.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 710.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 710.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 710.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN,LIMITED/LOCALIZED F/U STUDY", "code_information": [ { "code": "76380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 801.56, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 783.9376, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 783.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TCAT PLMT XTRC VRT CRTD STENT RS&IPRQ EA VSL", "code_information": [ { "code": "0076T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21194.1, "minimum": 2944.0066, "maximum": 18481.2552, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2944.01 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CCMCC", "code_information": [ { "code": "742", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15002.0, "minimum": 12643.19, "maximum": 57935.7759, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14437.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33154.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14437.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 49298.56, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 51025.99, "10th_percentile": 51025.99, "90th_percentile": 51025.99, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14437.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33396.61 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15002.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12643.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15002.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33396.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14437.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15002.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14437.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20406.06 } ] } ] }, { "description": "Hydromorpone HCl-Sodium Chloride 0.9% Inj 6 MG/30ML", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "09999408225", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.98, "10th_percentile": 11.99, "90th_percentile": 39.11, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 44.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7024.0, "minimum": 4694.74, "maximum": 14199.2803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6782.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14199.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6782.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6782.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11524.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7024.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4694.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7024.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11524.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6782.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7024.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6782.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8739.42 } ] } ] }, { "description": "HC (SUP SHELL A6454) SELF-ADHER BAND W>=3 <5/YD - A6454 - 27100097", "code_information": [ { "code": "A6454", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.0884, "maximum": 1.8941, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.09, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF METHADONE - G0480 - 30100205", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.38, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY LUMBAR SPINE FLEX/EXTEN", "code_information": [ { "code": "72120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 693.13, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 604.4094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 263.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMV/REVISN BOOT/BODY CAST", "code_information": [ { "code": "29700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.56, "discounted_cash": 275.0, "minimum": 66.468, "maximum": 221.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 221.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO AORTOGRAM ABD SERIAL", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10859.1, "discounted_cash": 3115.0, "minimum": 526.4977, "maximum": 10859.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10859.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10859.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10859.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 7575.28, "10th_percentile": 7575.28, "90th_percentile": 7575.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT RADIAL HEAD DISLOC CHILD W AMNIP", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 535.94, "discounted_cash": 243.0, "minimum": 160.782, "maximum": 535.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 535.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 535.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 535.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC PRETREATMENT/ENZYM", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.5, "discounted_cash": 168.0, "minimum": 11.25, "maximum": 37.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CALCITONIN", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.44, "discounted_cash": 26.0, "minimum": 26.0345, "maximum": 822.6797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 119.75, "10th_percentile": 119.75, "90th_percentile": 119.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.54, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC APPLY SHORT LEG CAST", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.13, "discounted_cash": 275.0, "minimum": 110.439, "maximum": 368.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 368.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 368.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 368.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 368.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REAGENT STRIP/BLOOD GLUCOSE", "code_information": [ { "code": "82948", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.06, "discounted_cash": 5.0, "minimum": 4.8979, "maximum": 19.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM GATED HEART, PLANAR SINGLE", "code_information": [ { "code": "78472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1543.13, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1543.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1543.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1543.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1450.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC E COLI 0157 AG, EIA", "code_information": [ { "code": "87335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.5, "discounted_cash": 12.0, "minimum": 11.25, "maximum": 37.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 30.0, "10th_percentile": 30.0, "90th_percentile": 30.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.3, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HLA I TYPING 1 ALLELE HR", "code_information": [ { "code": "81381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 834.06, "discounted_cash": 169.0, "minimum": 165.1088, "maximum": 834.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.38, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 165.11, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 834.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3121.56, "discounted_cash": 696.0, "minimum": 696.49, "maximum": 3121.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3121.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KCl 40 MEQ/L (0.3%) in Dextrose 5% & NaCl 0.9% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00990710909", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON", "code_information": [ { "code": "93291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.75, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 216.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INBORN AND OTHER DISORDERS OF METABOLISM", "code_information": [ { "code": "642", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11863.0, "minimum": 8590.06, "maximum": 35435.4596, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11426.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25697.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11426.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11426.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22121.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11863.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8590.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11863.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22121.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11426.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11863.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11426.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15816.14 } ] } ] }, { "description": "HC (SUP SHELL C2638) BRACHYTX, STRANDED, I-125", "code_information": [ { "code": "C2638", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 35.0, "minimum": 35.09, "maximum": 167.9302, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.24, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.93, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 134.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT NAVICULAR FX W MANIP", "code_information": [ { "code": "25624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 1586.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC JAK2 GENE", "code_information": [ { "code": "81270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1830.63, "discounted_cash": 91.0, "minimum": 89.0752, "maximum": 1596.3094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.34, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 89.08, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 480.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 91.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 91.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 91.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 155.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY EXAM, BREAST SPECIMEN", "code_information": [ { "code": "76098", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.38, "discounted_cash": 539.0, "minimum": 80.814, "maximum": 269.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 66.19, "10th_percentile": 66.19, "90th_percentile": 66.19, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 75.13, "10th_percentile": 65.08, "90th_percentile": 76.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 98.5, "10th_percentile": 98.5, "90th_percentile": 98.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 85.89, "10th_percentile": 85.89, "90th_percentile": 85.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 269.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [ { "code": "329", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36006.0, "minimum": 31782.06, "maximum": 109091.8824, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34592.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 83058.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34592.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 95718.12, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 45257.31, "10th_percentile": 45257.31, "90th_percentile": 45257.31, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34592.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 69867.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36006.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31782.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36006.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69867.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34592.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 36006.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34592.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51120.8 } ] } ] }, { "description": "HC IGH@ VARIABLE REGION SOMATIC MUTATION ANALYSIS", "code_information": [ { "code": "81263", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1281.25, "discounted_cash": 294.0, "minimum": 286.2145, "maximum": 1281.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 357.75, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 286.21, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1281.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 498.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI UPPER EXTREM WO/W CONTRAST", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3405.31, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2969.4303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2816.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RADEX SPINE CERVICAL 2 OR 3 VIEWS", "code_information": [ { "code": "72040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 583.13, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 508.4894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 352.0, "10th_percentile": 352.0, "90th_percentile": 352.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 355.8, "10th_percentile": 355.8, "90th_percentile": 355.8, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 254.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Erythromycin Lactobionate For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409648211", "type": "NDC" }, { "code": "J1364", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 141.814, "maximum": 141.814, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.81 } ] } ] }, { "description": "HC RADEX SPINE CERVICAL 4 OR 5 VIEWS", "code_information": [ { "code": "72050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 686.9703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 475.6, "10th_percentile": 475.6, "90th_percentile": 475.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 488.31, "10th_percentile": 488.31, "90th_percentile": 488.31, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 376.91, "10th_percentile": 376.91, "90th_percentile": 376.91, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 480.69, "10th_percentile": 462.16, "90th_percentile": 480.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 359.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 161.99, "10th_percentile": 161.99, "90th_percentile": 475.6, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 523.16, "10th_percentile": 483.15, "90th_percentile": 549.58, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI ABDOMEN W CONTRAST", "code_information": [ { "code": "74182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2698.75, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2353.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2021.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1729) CATHETER DRAINAGE", "code_information": [ { "code": "C1729", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 119.97, "10th_percentile": 119.97, "90th_percentile": 262.75, "count": "15" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 131.49, "10th_percentile": 131.49, "90th_percentile": 131.49, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 310.21, "10th_percentile": 310.21, "90th_percentile": 310.21, "count": "1 through 10" } ] } ] }, { "description": "HC PLATELETS LEUKOCYTES REDUCED EA UNIT", "code_information": [ { "code": "P9031", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4606.56, "discounted_cash": 143.0, "minimum": 143.55, "maximum": 4016.9203, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 549.61, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 143.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 143.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 143.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 242.77, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 565.53, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 686.99, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ETHANOL - 80320 - 30100052", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1165.0, "minimum": 58.8211, "maximum": 1015.88, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.82 } ] } ] }, { "description": "HC NM THERAPY, ORAL", "code_information": [ { "code": "79005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 596.88, "discounted_cash": 230.0, "minimum": 179.064, "maximum": 596.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 596.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 596.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 596.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 450.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 389.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IV INFU, HYDRATION, 31-60 MIN", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 247.5, "discounted_cash": 209.0, "minimum": 74.25, "maximum": 247.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 133.06, "10th_percentile": 133.06, "90th_percentile": 133.06, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 247.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 247.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 304.06, "10th_percentile": 304.06, "90th_percentile": 304.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 305.49, "10th_percentile": 305.49, "90th_percentile": 305.49, "count": "16" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 156.82, "10th_percentile": 155.43, "90th_percentile": 156.82, "count": "11" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 347.49, "10th_percentile": 203.91, "90th_percentile": 350.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29471.0, "minimum": 24806.05, "maximum": 67532.413, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28321.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 67532.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28321.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28321.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56061.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 29471.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24806.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29471.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56061.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28321.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 29471.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28321.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41565.05 } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13021.0, "minimum": 10420.75, "maximum": 39037.3355, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12536.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28447.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12536.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12536.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27128.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10420.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27128.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 39037.34, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18448.79, "10th_percentile": 18448.79, "90th_percentile": 18448.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12536.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13021.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12536.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17508.86 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20235.0, "minimum": 17080.46, "maximum": 52106.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19459.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 45588.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19459.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19459.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 52106.58 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17080.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52106.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19459.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20235.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19459.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28058.89 } ] } ] }, { "description": "HC (SUP SHELL L0637) LSO SC R ANT/POS PNL PRE CST", "code_information": [ { "code": "L0637", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1404.0, "minimum": 1364.9223, "maximum": 2375.3411, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1404.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1404.53, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1706.08, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1404.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1364.92, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1404.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1404.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1404.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1530.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1404.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1404.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1404.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1404.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1404.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2375.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46730.0, "minimum": 42873.49, "maximum": 192987.5215, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44882.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 108538.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 44882.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 44882.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 71960.24 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 46730.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42873.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46730.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71960.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 44882.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 46730.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44882.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66803.48 } ] } ] }, { "description": "HC (SUP SHELL A5061) POUCH DRAINABLE W BARRIER AT", "code_information": [ { "code": "A5061", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 4.8979, "maximum": 8.5236, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8670.0, "minimum": 7031.38, "maximum": 27846.313, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8362.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18111.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8362.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8362.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15538.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8670.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7031.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8670.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15538.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8362.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8670.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8362.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11147.26 } ] } ] }, { "description": "HC C-REACTIVE PROTEIN,HIGH SENSITIVITY", "code_information": [ { "code": "86141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.38, "discounted_cash": 12.0, "minimum": 12.5848, "maximum": 152.0594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 105.2, "10th_percentile": 88.37, "90th_percentile": 105.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.73, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 93.84, "10th_percentile": 93.84, "90th_percentile": 93.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 115.72, "10th_percentile": 67.95, "90th_percentile": 121.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SINUS AND MASTOID PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "136", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8769.0, "minimum": 6770.45, "maximum": 21957.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8457.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18346.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8457.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8457.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21957.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8769.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6770.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8769.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21957.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8457.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8769.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8457.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11291.84 } ] } ] }, { "description": "HC (SUP SHELL Q4126) MEMODERM/DERMA/TRANZ/INTEGUP", "code_information": [ { "code": "Q4126", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLD CLOT FACTOR VIII TEST, VW FC, MULTIMET ANAL", "code_information": [ { "code": "85247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 483.75, "discounted_cash": 22.0, "minimum": 22.2931, "maximum": 421.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TOBRAMYCIN", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.94, "discounted_cash": 16.0, "minimum": 15.6751, "maximum": 236.2597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.59, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.68, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH (93356)", "code_information": [ { "code": "93356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.5, "minimum": 15.75, "maximum": 45.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 26.88, "10th_percentile": 26.88, "90th_percentile": 26.88, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 31.1, "10th_percentile": 31.1, "90th_percentile": 31.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 30.66, "10th_percentile": 30.66, "90th_percentile": 30.66, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 8.59, "10th_percentile": 8.59, "90th_percentile": 31.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 34.88, "10th_percentile": 30.66, "90th_percentile": 35.2, "count": "1 through 10" } ] } ] }, { "description": "HC ELECTROPHYSIOLOGIC F/U STUDY", "code_information": [ { "code": "93624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22464.7, "discounted_cash": 7695.0, "minimum": 6739.41, "maximum": 22464.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22464.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22464.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22464.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8388.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13015.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECTION THERAPY VEIN,MULT VEINS", "code_information": [ { "code": "36471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450.63, "discounted_cash": 401.0, "minimum": 135.189, "maximum": 450.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 450.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 450.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 450.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 450.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Linezolid IV Soln 600 MG/300ML (2 MG/ML)", "drug_information": { "unit": 300.0, "type": "ML" }, "code_information": [ { "code": "55150024251", "type": "NDC" }, { "code": "J2020", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.4605, "maximum": 7.4605, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.46 } ] } ] }, { "description": "Dopamine HCl Inj 40 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409910421", "type": "NDC" }, { "code": "J1265", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.5265, "maximum": 1.5265, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.53 } ] } ] }, { "description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC", "code_information": [ { "code": "319", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34990.0, "minimum": 30404.02, "maximum": 96517.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33617.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 80643.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 33617.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33617.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 96517.2 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 34990.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30404.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34990.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 96517.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33617.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 34990.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33617.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49634.95 } ] } ] }, { "description": "HC IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ", "code_information": [ { "code": "87637", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 750.63, "discounted_cash": 142.0, "minimum": 138.6078, "maximum": 748.4606, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 173.25, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 138.61, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 748.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 241.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRUG ASSAY EVEROLIMUS", "code_information": [ { "code": "80169", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1002.5, "discounted_cash": 13.0, "minimum": 13.3428, "maximum": 874.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6010) COLLAGEN BASED WOUND FILLER", "code_information": [ { "code": "A6010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 44.0, "minimum": 42.8953, "maximum": 74.6496, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.14, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.62, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.9, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 44.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 44.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 44.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CCMCC", "code_information": [ { "code": "734", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17247.0, "minimum": 14554.17, "maximum": 46064.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23689.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16592.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38488.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16592.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16592.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46064.76 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17247.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14554.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17247.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46064.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16592.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17247.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16592.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12648.0, "minimum": 10714.22, "maximum": 54353.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12179.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27561.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12179.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12179.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22345.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12648.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10714.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12648.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22345.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12179.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12648.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12179.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16963.9 } ] } ] }, { "description": "HC US PELVIS NONOBST LIMITED/FU", "code_information": [ { "code": "76857", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 591.0503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 52.61, "10th_percentile": 52.61, "90th_percentile": 105.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 373.11, "10th_percentile": 373.11, "90th_percentile": 373.11, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 448.85, "10th_percentile": 431.65, "90th_percentile": 448.85, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C2616) Y90 BRACHYTHERAPY", "code_information": [ { "code": "C2616", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 17683.0, "minimum": 17683.93, "maximum": 84629.9838, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17683.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69667.61, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 84629.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17683.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 67706.46, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37592.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17683.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17683.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17683.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19275.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17683.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17683.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17683.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17683.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17683.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29907.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A2013) INNOVAMATRIX FS, PER SQ CM", "code_information": [ { "code": "A2013", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 2960.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2960.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3540) ORTHO SHOE ADD FULL SOLE", "code_information": [ { "code": "L3540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 61.0, "minimum": 59.3187, "maximum": 103.2308, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.04, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.15, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.32, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 61.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 61.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 61.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 61.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<", "code_information": [ { "code": "11305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 617.81, "discounted_cash": 197.0, "minimum": 185.343, "maximum": 617.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 617.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 617.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 617.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Pegfilgrastim-jmdb Soln Prefilled Syringe 6 MG/0.6ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "83257000541", "type": "NDC" }, { "code": "Q5108", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 79.0, "minimum": 79.498, "maximum": 313.1903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 313.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.41, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 96.33, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 79.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 79.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 79.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 79.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 134.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ELECTROPHYS EV,R A-V PACE/REC,W/O INDUCT", "code_information": [ { "code": "93620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22464.7, "discounted_cash": 7695.0, "minimum": 6739.41, "maximum": 22464.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22464.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22464.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22464.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8388.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13015.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC APPLY LONG LEG CAST", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 533.44, "discounted_cash": 275.0, "minimum": 160.032, "maximum": 533.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 533.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 533.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 533.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 466.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF AMIKACIN", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.06, "discounted_cash": 15.0, "minimum": 14.6547, "maximum": 129.9803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.32, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF GGT", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.94, "discounted_cash": 7.0, "minimum": 6.997, "maximum": 131.6197, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 76.92, "10th_percentile": 76.92, "90th_percentile": 153.84, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 81.23, "10th_percentile": 81.23, "90th_percentile": 82.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 32.18, "10th_percentile": 32.18, "90th_percentile": 32.18, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 37.78, "10th_percentile": 37.66, "90th_percentile": 106.26, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.18, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 32.18, "10th_percentile": 32.18, "90th_percentile": 81.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC", "code_information": [ { "code": "740", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14810.0, "minimum": 12585.05, "maximum": 41022.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14254.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32699.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14254.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14254.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41022.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12585.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41022.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14254.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14254.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20125.79 } ] } ] }, { "description": "HC (SUP SHELL C9356) TENOGLIDE TENDON PROT, CM2", "code_information": [ { "code": "C9356", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 240.9075, "maximum": 240.9075, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.91 } ] } ] }, { "description": "KCl 20 MEQ/L (0.15%) in Dextrose 5% & NaCl 0.9% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338080304", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8506.0, "minimum": 6823.74, "maximum": 25331.3221, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 22804.0, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5155.88, "10th_percentile": 5155.88, "90th_percentile": 5155.88, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8204.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17721.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8204.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8204.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17081.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8506.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6823.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8506.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17081.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8204.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8506.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8204.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10907.03 } ] } ] }, { "description": "HC EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6551.56, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 5712.9603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3343.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INCISION & DRAIN SKIN ABSCESS SIMPLE", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 197.0, "minimum": 197.97, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 425.8, "10th_percentile": 357.67, "90th_percentile": 425.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 438.62, "10th_percentile": 438.62, "90th_percentile": 438.62, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC", "code_information": [ { "code": "435", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15016.0, "minimum": 12628.66, "maximum": 42062.0972, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14451.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33188.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14451.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14451.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 35247.54 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15016.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12628.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15016.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35247.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14451.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15016.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14451.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20427.19 } ] } ] }, { "description": "HC CHEMOTHER, IV INFUSION, EA ADD HR", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.94, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 310.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 195.27, "10th_percentile": 187.7, "90th_percentile": 195.27, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 279.87, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 310.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.99, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 181.68, "10th_percentile": 181.68, "90th_percentile": 381.38, "count": "18" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 195.27, "10th_percentile": 187.7, "90th_percentile": 195.27, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 381.38, "10th_percentile": 208.56, "90th_percentile": 437.8, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC", "code_information": [ { "code": "070", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13709.0, "minimum": 12034.81, "maximum": 40215.9699, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13197.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30082.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13197.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13197.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30341.61 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13709.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12034.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13709.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30341.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13197.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13709.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13197.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18515.37 } ] } ] }, { "description": "HC REPR WND CPLX SCALP 1.1-2.5 CM", "code_information": [ { "code": "13120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1836.25, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 1836.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT NAVICULAR FX WO MANIP", "code_information": [ { "code": "25622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ FOR CHOLANGIOGRAM, NEW ACCESS", "code_information": [ { "code": "47532", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7787.81, "discounted_cash": 3532.0, "minimum": 2336.343, "maximum": 7787.81, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7787.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7787.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7787.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITH CC", "code_information": [ { "code": "620", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13218.0, "minimum": 11053.36, "maximum": 38442.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12726.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28917.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12726.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12726.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38442.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13218.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11053.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13218.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38442.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12726.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13218.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12726.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17798.02 } ] } ] }, { "description": "Betamethasone Sod Phosphate & Acetate Inj Susp 6 (3-3) MG/ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00517072001", "type": "NDC" }, { "code": "J0702", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 14.7275, "maximum": 14.7275, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.73 } ] } ] }, { "description": "HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS", "code_information": [ { "code": "49450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3151.88, "discounted_cash": 894.0, "minimum": 894.92, "maximum": 3151.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3151.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3151.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3151.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC", "code_information": [ { "code": "605", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8014.0, "minimum": 6393.23, "maximum": 16551.9734, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7732.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16551.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7732.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7732.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14485.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8014.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6393.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8014.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14486.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7732.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8014.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7732.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10187.46 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "831", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10193.0, "minimum": 6607.2101, "maximum": 21728.9826, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9823.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21728.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9823.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 8616.29, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 2721.88, "10th_percentile": 2721.88, "90th_percentile": 2721.88, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9823.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12611.65 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10193.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7966.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10193.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12611.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9823.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10193.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9823.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13373.82 } ] } ] }, { "description": "KCl 20 MEQ/L (0.15%) in Dextrose 5% & NaCl 0.45% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338067104", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "314", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16906.0, "minimum": 14905.08, "maximum": 48729.5871, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16265.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37679.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16265.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16265.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39678.08 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16906.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14905.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16906.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39678.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16265.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16906.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16265.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23190.93 } ] } ] }, { "description": "HC SARS-COV-2 COVID-19 AMP PRB - 87635 - 30087635", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.5, "discounted_cash": 51.0, "minimum": 49.8631, "maximum": 182.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.31, "10th_percentile": 51.31, "90th_percentile": 51.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.33, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.86, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 87.75, "10th_percentile": 87.75, "90th_percentile": 87.75, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 98.21, "10th_percentile": 98.21, "90th_percentile": 98.21, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 182.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 121.22, "10th_percentile": 121.22, "90th_percentile": 121.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITH MCC", "code_information": [ { "code": "668", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23255.0, "minimum": 20184.67, "maximum": 63149.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22357.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 52763.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22357.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22357.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 63149.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23255.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20184.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23255.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 63149.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22357.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 23255.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22357.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32475.31 } ] } ] }, { "description": "HC (SUP SHELL A6545) GRAD COMP NON-ELASTIC BK", "code_information": [ { "code": "A6545", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 121.0, "minimum": 117.9862, "maximum": 205.3286, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.48, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 117.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 132.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4558) CONDUCTIVE GEL OR PASTE", "code_information": [ { "code": "A4558", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.4139, "maximum": 11.1619, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Carboprost Tromethamine IM Soln 250 MCG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "43598069811", "type": "NDC" }, { "code": "J0675", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 15.0, "minimum": 15.559, "maximum": 61.2962, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.3, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.05, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC STOOL CULTR AEROBIC BACT EA", "code_information": [ { "code": "87046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.81, "discounted_cash": 9.0, "minimum": 9.1738, "maximum": 32.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 31.53, "10th_percentile": 31.53, "90th_percentile": 31.53, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 33.94, "10th_percentile": 33.94, "90th_percentile": 35.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 52.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 43.56, "10th_percentile": 43.56, "90th_percentile": 99.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVE INTRAUTERINE DEVICE", "code_information": [ { "code": "58301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 755.63, "discounted_cash": 300.0, "minimum": 226.689, "maximum": 755.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1826.36, "10th_percentile": 1826.36, "90th_percentile": 1826.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 755.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 755.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 755.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 508.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SPECIAL STAINS,GROUP II", "code_information": [ { "code": "88313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.31, "discounted_cash": 131.0, "minimum": 67.593, "maximum": 225.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 135.74, "10th_percentile": 135.74, "90th_percentile": 135.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 225.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 225.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 225.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 123.58, "10th_percentile": 123.58, "90th_percentile": 123.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 121.13, "10th_percentile": 34.36, "90th_percentile": 278.17, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 793.1, "10th_percentile": 158.62, "90th_percentile": 901.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LYMPHANGIOGRAPHY PELVIC/ABDOMIN, UNILAT", "code_information": [ { "code": "75805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12169.1, "discounted_cash": 3115.0, "minimum": 1889.5687, "maximum": 12169.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12169.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12169.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1889.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "750", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12272.0, "minimum": 8925.06, "maximum": 26667.4699, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26667.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26195.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8925.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26195.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12272.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16413.38 } ] } ] }, { "description": "Dalbavancin HCl For IV Soln 500 MG (Base Equivalent)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "57970010001", "type": "NDC" }, { "code": "J0875", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 15.0, "minimum": 15.003, "maximum": 59.1058, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 4623.39, "10th_percentile": 4623.39, "90th_percentile": 4623.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.11, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 4623.39, "10th_percentile": 4623.39, "90th_percentile": 4623.39, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PHYS THRP RE-EVAL, 20 MIN", "code_information": [ { "code": "97164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.88, "discounted_cash": 64.0, "minimum": 62.72, "maximum": 276.3194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.54, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.4, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.72, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 64.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 64.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 64.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4354) CATH INSERTION TRAY W/BAG", "code_information": [ { "code": "A4354", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 16.0, "minimum": 16.3554, "maximum": 28.4629, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.36, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC", "code_information": [ { "code": "625", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24017.0, "minimum": 19844.15, "maximum": 65314.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23087.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 54572.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23087.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23087.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 65314.42 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19844.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65314.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23087.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24017.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23087.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33588.59 } ] } ] }, { "description": "HC (SUP SHELL L8612) AQUEOUS SHUNT", "code_information": [ { "code": "L8612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 878.0, "minimum": 853.6097, "maximum": 1485.5163, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 878.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1066.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 853.61, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 957.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1485.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVE RENAL TUBE W/FLUORO", "code_information": [ { "code": "50389", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2825.94, "discounted_cash": 688.0, "minimum": 688.02, "maximum": 2825.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2710.52, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2825.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2634.22, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 749.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1163.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4314) CATH W/DRAINAGE 2-WAY LATEX", "code_information": [ { "code": "A4314", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 30.0, "minimum": 29.7662, "maximum": 51.8015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.21, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.77, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.39, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL E0749) ELEC OSTEOGEN STIM IMPLANTED", "code_information": [ { "code": "E0749", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 405.0, "minimum": 393.8317, "maximum": 685.3757, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 405.26, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 492.27, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 393.83, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 405.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 405.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 441.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 405.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 405.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 685.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6021) COLLAGEN DRESSING <=16 SQ IN - A6021 - RU272038", "code_information": [ { "code": "A6021", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 29.0, "minimum": 29.1248, "maximum": 50.6853, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.4, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE", "code_information": [ { "code": "49460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2190.0, "discounted_cash": 894.0, "minimum": 657.0, "maximum": 2190.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2190.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2190.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2190.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Insulin Aspart Prot & Aspart (Human) Inj 100 Unit/ML (70-30)", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00169369619", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ENTEROVIRUS, ANTIBODY", "code_information": [ { "code": "86658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.69, "discounted_cash": 13.0, "minimum": 12.6626, "maximum": 296.2097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4327) FEM URINARY COLLECT DEV CUP", "code_information": [ { "code": "A4327", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 60.0, "minimum": 58.5315, "maximum": 101.861, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.16, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 58.53, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 101.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEHYDROEPIANDROSTERONE", "code_information": [ { "code": "82626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 364.38, "discounted_cash": 25.0, "minimum": 24.5574, "maximum": 317.7394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 112.96, "10th_percentile": 112.96, "90th_percentile": 112.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.7, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 199.85, "10th_percentile": 196.09, "90th_percentile": 199.85, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 132.6, "10th_percentile": 132.6, "90th_percentile": 256.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.74, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6248) HYDROGEL DRSG GEL FILLER - A6248 - RU272052", "code_information": [ { "code": "A6248", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "minimum": 22.4972, "maximum": 39.1513, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN OF LEG CONTRAST", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2168.75, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1891.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1023.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1382.56, "10th_percentile": 1382.56, "90th_percentile": 1382.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hepatitis A Vaccine Susp Prefilled Syr 1440 EL Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "58160082652", "type": "NDC" }, { "code": "90632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 155.144, "maximum": 155.144, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.14 } ] } ] }, { "description": "HC EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER), 15 MIN", "code_information": [ { "code": "92521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 535.31, "discounted_cash": 128.0, "minimum": 95.0, "maximum": 466.7903, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.3, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.08, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX", "code_information": [ { "code": "57180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 759.06, "discounted_cash": 199.0, "minimum": 199.48, "maximum": 759.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 759.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 759.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 759.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 337.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US, BREAST UNILAT COMPLETE", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 612.19, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 599.6067, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 266.28, "10th_percentile": 266.28, "90th_percentile": 266.28, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 280.07, "10th_percentile": 280.07, "90th_percentile": 280.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 343.42, "10th_percentile": 343.42, "90th_percentile": 343.42, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 599.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THROMBOPLAS TIME PARTIAL", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.94, "discounted_cash": 6.0, "minimum": 5.8405, "maximum": 127.2597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 88.2, "10th_percentile": 74.09, "90th_percentile": 88.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 70.23, "10th_percentile": 70.23, "90th_percentile": 74.37, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 78.54, "10th_percentile": 75.59, "90th_percentile": 157.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 26.86, "10th_percentile": 26.86, "90th_percentile": 26.86, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 97.02, "10th_percentile": 31.43, "90th_percentile": 101.81, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "855", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12434.0, "minimum": 11251.31, "maximum": 27054.1644, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11974.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27054.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11974.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11974.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18051.43 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12434.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11251.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12434.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18051.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11974.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12434.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11974.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16651.38 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9472.0, "minimum": 7772.65, "maximum": 23457.0063, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9131.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20015.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9131.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9131.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19389.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9472.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7772.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9472.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19389.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 23457.01, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18479.26, "10th_percentile": 18479.26, "90th_percentile": 24092.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9131.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9472.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9131.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12319.48 } ] } ] }, { "description": "Phytonadione Inj 1 MG/0.5ML (2 MG/ML)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "76329124001", "type": "NDC" }, { "code": "J3430", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.2675, "maximum": 5.2675, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.27 } ] } ] }, { "description": "HC TUMOR IMMUNOHISTOCHEM/MANUAL", "code_information": [ { "code": "88360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 621.88, "discounted_cash": 168.0, "minimum": 168.1, "maximum": 621.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 334.32, "10th_percentile": 240.41, "90th_percentile": 714.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 621.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 621.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 621.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 334.67, "10th_percentile": 245.27, "90th_percentile": 1162.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 522.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 625.0, "10th_percentile": 625.0, "90th_percentile": 625.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 433.82, "10th_percentile": 314.82, "90th_percentile": 623.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "825", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11310.0, "minimum": 8518.77, "maximum": 42115.0974, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24383.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22933.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11310.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8518.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11310.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22934.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11310.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10895.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15007.59 } ] } ] }, { "description": "HC (SUP SHELL L1685) POST-OP HIP ABDUCT CUSTOM FA", "code_information": [ { "code": "L1685", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1822.0, "minimum": 1771.0861, "maximum": 3082.1782, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1822.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1822.48, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2213.77, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1822.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1771.09, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1822.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1822.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1822.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1986.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1822.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1822.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1822.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1822.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1822.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3082.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "965", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8200.0, "minimum": 6316.41, "maximum": 20105.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7911.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16994.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7911.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7911.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20104.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8200.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6316.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8200.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20105.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7911.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8200.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7911.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10459.94 } ] } ] }, { "description": "HC CLSD TREAT KNEE DISLOC WO ANES", "code_information": [ { "code": "27550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4038) CAST SUP SHRT LEG FIBERGLASS", "code_information": [ { "code": "Q4038", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 52.0, "minimum": 51.0001, "maximum": 88.7542, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.48, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.75, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 52.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 52.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 52.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1889) IMPLANT/INSERT DEVICE, NOC - C1889 - 27800076", "code_information": [ { "code": "C1889", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 6405.84, "10th_percentile": 660.07, "90th_percentile": 6405.84, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 2538.76, "10th_percentile": 665.92, "90th_percentile": 5397.48, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L0174) CERV SR 2PC THOR EXT PRE OTS", "code_information": [ { "code": "L0174", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 420.0, "minimum": 409.0209, "maximum": 711.8092, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 511.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 409.02, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 458.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 711.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CARBAMAZEPINE TOTAL", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 239.06, "discounted_cash": 14.0, "minimum": 14.1591, "maximum": 208.4603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 121.3, "10th_percentile": 121.3, "90th_percentile": 121.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.7, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, JOINT UPPER EXTREM COMBO", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.94, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 3270.8197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2609.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1140.74, "10th_percentile": 1140.74, "90th_percentile": 1140.74, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NON-INV PHYSIOLOGIC STD EXTREM ART 1-2 LVL, LMT", "code_information": [ { "code": "93922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 910.31, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 793.7903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 628.22, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.68, "10th_percentile": 206.68, "90th_percentile": 206.68, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARC COLD AGGLUTININ, TITER", "code_information": [ { "code": "86157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 295.0, "discounted_cash": 8.0, "minimum": 7.8327, "maximum": 257.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.79, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY TMJ BILAT", "code_information": [ { "code": "70330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 771.88, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 673.0794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Tigecycline For IV Soln 50 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "71288001910", "type": "NDC" }, { "code": "J3243", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Cefiderocol Sulfate Tosylate For IV Soln 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "59630026601", "type": "NDC" }, { "code": "J0699", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.3518, "maximum": 9.5299, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.53, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC PRETREATMENT,SERUM DILUTN", "code_information": [ { "code": "86976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.19, "discounted_cash": 28.0, "minimum": 15.657, "maximum": 52.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 52.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "826", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36624.0, "minimum": 33052.81, "maximum": 96030.11, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 84527.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 35185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 96030.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36624.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33052.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36624.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 96030.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 36624.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52024.99 } ] } ] }, { "description": "HC (SUP SHELL A6235) HYDROCOLLD DRG >16<=48 W/O B - A6235 - RU272051", "code_information": [ { "code": "A6235", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "minimum": 23.294, "maximum": 40.5381, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11416.0, "minimum": 9483.61, "maximum": 41314.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10997.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24634.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10997.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10997.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41314.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11416.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9483.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11416.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41314.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10997.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11416.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10997.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15162.19 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6312.0, "minimum": 5128.71, "maximum": 14969.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6099.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12507.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6099.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6099.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14969.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6312.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5128.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6312.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14969.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6099.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6312.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6099.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7698.43 } ] } ] }, { "description": "HC (SUP SHELL A6442) CONFORM BAND N/S W<3/YD", "code_information": [ { "code": "A6442", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TREAT WND DEHISCENCE, SIMPLE CLOSURE", "code_information": [ { "code": "12020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2362.81, "discounted_cash": 729.0, "minimum": 708.843, "maximum": 2362.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CCMCC", "code_information": [ { "code": "489", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9541.0, "minimum": 8571.38, "maximum": 25885.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20180.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25885.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9541.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8571.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9541.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25885.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9541.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12420.69 } ] } ] }, { "description": "HC CLSD TREAT WEIGHT BEAR DIST TIB W MANIP", "code_information": [ { "code": "27825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.38, "discounted_cash": 1586.0, "minimum": 251.814, "maximum": 839.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17877.0, "minimum": 15318.98, "maximum": 70355.6022, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 63336.18, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 50333.21, "10th_percentile": 50333.21, "90th_percentile": 50333.21, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17196.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39984.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17196.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 61536.95, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 37709.52, "10th_percentile": 37709.52, "90th_percentile": 37709.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 61730.59, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 25853.78, "10th_percentile": 25853.78, "90th_percentile": 42386.64, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17196.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40845.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15318.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40845.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 70355.6, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 36638.75, "10th_percentile": 36638.75, "90th_percentile": 36638.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17196.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17196.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24610.05 } ] } ] }, { "description": "HC (SUP SHELL A4390) DRAINABLE PCH EX WEAR CONVEX", "code_information": [ { "code": "A4390", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 13.0, "minimum": 13.2942, "maximum": 23.1356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.62, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT", "code_information": [ { "code": "33019", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4845.31, "minimum": 1453.593, "maximum": 4845.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 4845.31 } ] } ] }, { "description": "HC ARTHROGRAM OF HIP", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 512.19, "discounted_cash": 344.0, "minimum": 153.657, "maximum": 512.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 409.75, "10th_percentile": 409.75, "90th_percentile": 409.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 512.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 512.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 512.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 318.54, "10th_percentile": 318.54, "90th_percentile": 318.54, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 512.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 360.58, "10th_percentile": 360.58, "90th_percentile": 360.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EXPLORE WOUND EXTREMITY", "code_information": [ { "code": "20103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2199.69, "discounted_cash": 1629.0, "minimum": 659.907, "maximum": 2199.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2199.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2199.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2199.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2199.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ELECTROPHYS EV,R A-V PACE/REC,W/ INDUCT", "code_information": [ { "code": "93619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22464.7, "discounted_cash": 7695.0, "minimum": 6739.41, "maximum": 22464.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22464.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22464.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22464.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8388.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13015.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOGRAM ADRENAL UNILAT", "code_information": [ { "code": "75840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1634.06, "discounted_cash": 3115.0, "minimum": 490.218, "maximum": 1634.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 658.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DLYD PLACEMENT XTN PROSTH FOR EVASC RPR 1ST VSL", "code_information": [ { "code": "34710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6537.81, "minimum": 1961.343, "maximum": 6537.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6537.81 } ] } ] }, { "description": "HC ASSAY, AMINOLEVULINIC ACID", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.44, "discounted_cash": 16.0, "minimum": 15.9861, "maximum": 173.0397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.99, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ VERTEBRAL AUGMENTATION, LUMBAR", "code_information": [ { "code": "22514", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39276.9, "discounted_cash": 7159.0, "minimum": 7159.72, "maximum": 34264.272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28206.43, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34264.27, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27412.42, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12108.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS - 98962 - 42998962", "code_information": [ { "code": "98962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.75, "minimum": 20.625, "maximum": 68.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.75 } ] } ] }, { "description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC", "code_information": [ { "code": "862", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14918.0, "minimum": 12726.25, "maximum": 32953.9672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32953.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22898.92 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14918.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12726.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14918.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22898.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14918.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20282.61 } ] } ] }, { "description": "HC HEMOGLOBIN", "code_information": [ { "code": "85018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.94, "discounted_cash": 2.0, "minimum": 2.3032, "maximum": 40.0597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.35, "10th_percentile": 23.35, "90th_percentile": 33.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.3, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 23.41, "10th_percentile": 23.41, "90th_percentile": 27.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 10.59, "10th_percentile": 10.59, "90th_percentile": 10.59, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 30.58, "10th_percentile": 30.58, "90th_percentile": 30.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY THOR-LUMB SP 2 VW", "code_information": [ { "code": "72080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 639.69, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 557.8097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION", "code_information": [ { "code": "96377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201.88, "discounted_cash": 46.0, "minimum": 46.2, "maximum": 201.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 201.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 140.82, "10th_percentile": 140.82, "90th_percentile": 161.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD GASES: PH, PO2 & PCO2 W O2 SATU", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 428.44, "discounted_cash": 78.0, "minimum": 76.5487, "maximum": 413.3219, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 230.33, "10th_percentile": 230.33, "90th_percentile": 230.33, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 76.55, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 253.25, "10th_percentile": 253.25, "90th_percentile": 253.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 413.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 342.75, "10th_percentile": 342.75, "90th_percentile": 342.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.86, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 298.88, "10th_percentile": 298.88, "90th_percentile": 301.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00143992490", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7845, "maximum": 1.7845, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.87, "10th_percentile": 11.99, "90th_percentile": 26.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.78 } ] } ] }, { "description": "HC CLSD TREAT METACARPAL FX WO MANIP EA", "code_information": [ { "code": "26600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 470.63, "discounted_cash": 243.0, "minimum": 141.189, "maximum": 470.63, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 470.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 470.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 470.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC DEBRIDEMENT, INFECTED SKIN, UP TO 10% BSA", "code_information": [ { "code": "11000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 810.94, "discounted_cash": 401.0, "minimum": 243.282, "maximum": 810.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 810.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 810.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 810.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7524) TRACHEOSTOMA STENT/STUD/BTTN", "code_information": [ { "code": "A7524", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 110.0, "minimum": 107.2187, "maximum": 186.5901, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.22, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 110.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 110.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 110.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 110.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 186.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC", "code_information": [ { "code": "177", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12933.0, "minimum": 11188.33, "maximum": 35107.2141, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 31604.54, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 33288.82, "10th_percentile": 33288.82, "90th_percentile": 36514.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12452.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28237.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12452.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12452.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26135.12 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12933.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11188.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12933.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26135.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12452.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12933.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12452.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17379.85 } ] } ] }, { "description": "HC MRA ABDOMEN ANGIO - C8902 - 61800003", "code_information": [ { "code": "C8902", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3124.69, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2724.7297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSESSMENT OF APHASIA", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 517.5, "discounted_cash": 93.0, "minimum": 90.9605, "maximum": 451.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.7, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 90.96, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 158.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF AMITRIPTYLINE - 80335 - 30100408", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.25, "minimum": 26.236, "maximum": 192.93, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.24 } ] } ] }, { "description": "HC (SUP SHELL A6219) GAUZE <= 16 SQ IN W/BORDER - A6219 - RU272028", "code_information": [ { "code": "A6219", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.3216, "maximum": 2.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26085.0, "minimum": 22985.04, "maximum": 90868.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25072.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 59487.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25072.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25072.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 90868.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 26085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22985.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 90868.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25072.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 26085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25072.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36613.68 } ] } ] }, { "description": "HC ASSAY OF CREATININE", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.5, "discounted_cash": 5.0, "minimum": 4.9756, "maximum": 54.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 40.0, "10th_percentile": 33.6, "90th_percentile": 40.0, "count": "24" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 31.85, "10th_percentile": 31.85, "90th_percentile": 31.85, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 34.28, "10th_percentile": 33.64, "90th_percentile": 34.28, "count": "29" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 22.89, "10th_percentile": 22.89, "90th_percentile": 33.6, "count": "19" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 43.6, "10th_percentile": 26.87, "90th_percentile": 44.0, "count": "44" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL OF FOREIGN BODY DEEP/COMPLEX", "code_information": [ { "code": "20525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2327.5, "discounted_cash": 2866.0, "minimum": 698.25, "maximum": 2327.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2327.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HIV-1/HIV-2, SINGLE ASSAY", "code_information": [ { "code": "86703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.06, "discounted_cash": 13.0, "minimum": 13.3234, "maximum": 99.4603, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 79.57, "10th_percentile": 71.94, "90th_percentile": 79.57, "count": "75" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.19, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 68.8, "10th_percentile": 61.28, "90th_percentile": 68.8, "count": "29" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 16.35, "10th_percentile": 16.35, "90th_percentile": 16.35, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 61.38, "10th_percentile": 58.96, "90th_percentile": 61.38, "count": "34" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 61.28, "10th_percentile": 61.28, "90th_percentile": 68.8, "count": "12" } ] } ] }, { "description": "HC HETEROPHILE ANTIBODIES,SCREEN", "code_information": [ { "code": "86308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.44, "discounted_cash": 5.0, "minimum": 5.0339, "maximum": 103.2797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 60.14, "10th_percentile": 60.14, "90th_percentile": 71.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 57.01, "10th_percentile": 57.01, "90th_percentile": 57.01, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 63.74, "10th_percentile": 61.36, "90th_percentile": 63.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.15, "10th_percentile": 23.15, "90th_percentile": 71.6, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 78.76, "10th_percentile": 27.18, "90th_percentile": 82.62, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Measles-Mumps-Rubella Virus Vaccines For Inj Soln", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00006468101", "type": "NDC" }, { "code": "90707", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 207.948, "maximum": 207.948, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.95 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "817", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18400.0, "minimum": 14242.6177, "maximum": 41228.1469, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17698.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 41228.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17698.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17698.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30785.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18400.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15129.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18400.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30785.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17698.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18400.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17698.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25375.23 } ] } ] }, { "description": "HC TRIIODOTHYRONINE FREE ASSAY (FT-3)", "code_information": [ { "code": "84481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.63, "discounted_cash": 16.0, "minimum": 16.4623, "maximum": 192.3894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 141.2, "10th_percentile": 118.61, "90th_percentile": 141.2, "count": "14" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 112.43, "10th_percentile": 112.43, "90th_percentile": 224.86, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 121.01, "10th_percentile": 118.73, "90th_percentile": 121.01, "count": "15" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 75.72, "10th_percentile": 75.72, "90th_percentile": 75.72, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 153.91, "10th_percentile": 153.91, "90th_percentile": 153.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1906) AFO MULTILIG ANK SUP PRE OTS", "code_information": [ { "code": "L1906", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 154.0, "minimum": 150.3861, "maximum": 261.7132, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 154.75, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 150.39, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 154.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 154.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 154.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 154.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 261.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4205) MEMBRANE GRAFT OR WRAP SQ CM", "code_information": [ { "code": "Q4205", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 2270.3355, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2270.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF SEX HORMONE BINDING GLOBULIN", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.13, "discounted_cash": 21.0, "minimum": 21.1172, "maximum": 120.4494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 97.13, "10th_percentile": 97.13, "90th_percentile": 97.13, "count": "16" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.12, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 70.39, "10th_percentile": 70.39, "90th_percentile": 70.39, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 75.76, "10th_percentile": 74.33, "90th_percentile": 75.76, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 97.13, "10th_percentile": 97.13, "90th_percentile": 97.13, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 96.36, "10th_percentile": 96.36, "90th_percentile": 97.24, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ibutilide Fumarate Inj 1 MG/10ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00009379401", "type": "NDC" }, { "code": "J1742", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 219.0, "minimum": 219.215, "maximum": 863.6194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 863.62, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 362.35, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 289.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 219.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 219.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 238.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 219.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 219.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 219.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 370.74, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY WRIST 2 VW", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 434.38, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 266.39, "10th_percentile": 266.39, "90th_percentile": 266.39, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MASS SPECTROMETRY QUANT,NONSPEC", "code_information": [ { "code": "83789", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1299.69, "discounted_cash": 24.0, "minimum": 23.4301, "maximum": 1133.3297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.29, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.43, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 662.32, "10th_percentile": 662.32, "90th_percentile": 662.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 414.45, "10th_percentile": 414.45, "90th_percentile": 414.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6237) HYDROCOLLD DRG <=16 IN W/BDR", "code_information": [ { "code": "A6237", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 11.0, "minimum": 10.9522, "maximum": 19.0598, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NON-SPEECH DEVICE SERVICE", "code_information": [ { "code": "92606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 638.13, "minimum": 95.0, "maximum": 556.4494, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC DRUG SCREEN QUANT CLOZAPINE", "code_information": [ { "code": "80159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.56, "discounted_cash": 20.0, "minimum": 19.5818, "maximum": 105.7311, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.58, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "463", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44394.0, "minimum": 37382.1, "maximum": 102989.0531, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42641.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 102989.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 42641.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 42641.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 96168.45 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 44394.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37382.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44394.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 96168.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42641.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 44394.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42641.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63388.02 } ] } ] }, { "description": "HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR", "code_information": [ { "code": "94625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.56, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 261.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 261.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Potassium Chloride Inj 10 mEq/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338070948", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ASSAY OF URINE POTASSIUM", "code_information": [ { "code": "84133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.88, "discounted_cash": 4.0, "minimum": 4.5966, "maximum": 84.4794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEOXYRIBONUCLEASE, ANTIBODY", "code_information": [ { "code": "86215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.0, "discounted_cash": 13.0, "minimum": 12.8764, "maximum": 183.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CCMCC", "code_information": [ { "code": "482", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13452.0, "minimum": 10980.0, "maximum": 43553.2202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29471.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 35360.54 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13452.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10980.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13452.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35360.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 43553.22, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 40288.64, "10th_percentile": 40288.64, "90th_percentile": 40288.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13452.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12950.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18139.46 } ] } ] }, { "description": "HC ASSAY OF HEMOSIDERIN, QUAL", "code_information": [ { "code": "83070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.25, "discounted_cash": 4.0, "minimum": 4.6161, "maximum": 88.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.62, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.69, "discounted_cash": 19.0, "minimum": 18.8238, "maximum": 104.3697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.53, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7178.0, "minimum": 5633.96, "maximum": 14566.098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14566.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12927.28 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7178.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5633.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7178.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12927.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7178.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6930.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8965.19 } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITHOUT CCMCC", "code_information": [ { "code": "621", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12520.0, "minimum": 10117.6, "maximum": 36549.04, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 27762.31, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 23018.17, "10th_percentile": 23018.17, "90th_percentile": 29461.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 27849.67, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 27423.99, "10th_percentile": 27423.99, "90th_percentile": 27423.99, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12055.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36549.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10117.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36549.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12055.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12520.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12055.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16775.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12055.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27256.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12055.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Methylnaltrexone Bromide Soln Pref Syr 8 MG/0.4ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "65649055204", "type": "NDC" }, { "code": "J2212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.1175, "maximum": 3.1175, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.12 } ] } ] }, { "description": "HC TB INTRADERMAL TEST", "code_information": [ { "code": "86580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.56, "discounted_cash": 28.0, "minimum": 13.968, "maximum": 46.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4330) STOOL COLLECTION POUCH - A4330 - 27100041", "code_information": [ { "code": "A4330", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 9.9221, "maximum": 17.2672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1789) PROSTHESIS, BREAST, IMP", "code_information": [ { "code": "C1789", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 6449.56, "10th_percentile": 6449.56, "90th_percentile": 6449.56, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 8580.38, "10th_percentile": 8580.38, "90th_percentile": 8580.38, "count": "1 through 10" } ] } ] }, { "description": "HC PRP I/HERN INIT BLOCK >5 YR", "code_information": [ { "code": "49507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13836.6, "discounted_cash": 3532.0, "minimum": 3532.78, "maximum": 13836.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13836.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13836.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13525.95, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11834.0, "minimum": 8617.75, "maximum": 30672.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11398.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25628.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11398.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11398.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30672.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11834.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8617.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11834.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30672.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11398.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11834.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11398.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15773.88 } ] } ] }, { "description": "HC CLSD TREAT THUMB DISLOC W MANIP", "code_information": [ { "code": "26641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 443.44, "discounted_cash": 243.0, "minimum": 133.032, "maximum": 443.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT", "code_information": [ { "code": "78072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1756.25, "discounted_cash": 535.0, "minimum": 526.875, "maximum": 1756.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1756.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1756.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1756.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1756.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BONE MARROW BX, NEEDLE/TROCAR", "code_information": [ { "code": "38221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6482.5, "discounted_cash": 1629.0, "minimum": 1629.64, "maximum": 6482.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 4071.01, "10th_percentile": 4071.01, "90th_percentile": 4071.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6420.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6482.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6239.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHLAMYDIA, IGM, ANTIBODY", "code_information": [ { "code": "86632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.5, "discounted_cash": 12.0, "minimum": 12.3224, "maximum": 89.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2 - 80332 - 31080332", "code_information": [ { "code": "80332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.06, "minimum": 34.218, "maximum": 103.947, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.95 } ] } ] }, { "description": "HC PART REMV BONE, DISTAL PHALANX", "code_information": [ { "code": "26236", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7338.75, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 7338.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6250.61, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7338.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6074.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3912) HFO FLEXION GLOVE PRE OTS", "code_information": [ { "code": "L3912", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 106.0, "minimum": 103.6328, "maximum": 180.3496, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 106.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 180.35, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.64, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 129.54, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 103.63, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 106.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 106.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.24, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4122) DERMACELL", "code_information": [ { "code": "Q4122", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SEPTIC ARTHRITIS WITH CC", "code_information": [ { "code": "549", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10229.0, "minimum": 8340.89, "maximum": 37513.719, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9857.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21813.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9857.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9857.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16648.63 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10229.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8340.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10229.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16648.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9857.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10229.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9857.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13426.09 } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5772.0, "minimum": 4336.91, "maximum": 17843.9554, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5581.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11224.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5581.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5581.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8728.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5772.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4336.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5772.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8728.59 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 17843.96, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 14202.89, "10th_percentile": 14202.89, "90th_percentile": 16892.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5581.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5772.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5581.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6908.79 } ] } ] }, { "description": "HC (SUP SHELL A4435) 1PC OST PCH DRAIN HGH OUTPUT", "code_information": [ { "code": "A4435", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 7.9785, "maximum": 13.8848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "144", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14227.0, "minimum": 12158.7, "maximum": 31313.2257, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13694.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31313.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13694.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13694.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17237.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14227.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12158.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14227.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17237.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13694.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14227.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13694.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19272.76 } ] } ] }, { "description": "Cefoxitin Sodium For IV Soln 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567024525", "type": "NDC" }, { "code": "J0694", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.7715, "maximum": 10.7715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 73.24, "10th_percentile": 73.24, "90th_percentile": 73.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.77 } ] } ] }, { "description": "HC ASSAY OF TOTAL ESTRADIOL", "code_information": [ { "code": "82670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.63, "discounted_cash": 27.0, "minimum": 27.1521, "maximum": 305.7494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 188.5, "10th_percentile": 42.88, "90th_percentile": 224.4, "count": "11" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 178.68, "10th_percentile": 178.68, "90th_percentile": 178.68, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 192.31, "10th_percentile": 188.69, "90th_percentile": 192.31, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 56.61, "10th_percentile": 56.61, "90th_percentile": 124.89, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 244.6, "10th_percentile": 146.61, "90th_percentile": 246.84, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RENAL FAILURE WITH CC", "code_information": [ { "code": "683", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7708.0, "minimum": 6152.37, "maximum": 20972.0942, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7439.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15825.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7439.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 18401.09, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11040.04, "10th_percentile": 11040.04, "90th_percentile": 11040.04, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7439.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13252.66 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7708.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6152.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7708.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13252.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 20972.09, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5943.83, "10th_percentile": 5943.83, "90th_percentile": 11536.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7439.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7708.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7439.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9740.37 } ] } ] }, { "description": "HC (SUP SHELL C1717) BRACHYTX, NON-STR,HDR IR-192", "code_information": [ { "code": "C1717", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 355.0, "minimum": 355.74, "maximum": 1702.4649, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1401.47, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1702.46, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1362.02, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 736.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 355.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 355.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 387.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 355.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 355.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 601.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL V2630) ANTERIOR CHAMBER INTRAOCULAR LENS", "code_information": [ { "code": "V2630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 145.0, "minimum": 141.6204, "maximum": 246.4586, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.02, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.62, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 158.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTRO CATH DIALYSIS CIRC W/TRLUML BALO ANGIOP S&I", "code_information": [ { "code": "36902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22145.3, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 22145.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22124.32, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22145.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [ { "code": "299", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13465.0, "minimum": 11195.94, "maximum": 35706.0657, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12963.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21607.16 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13465.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11195.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13465.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21607.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12963.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13465.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12963.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18158.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12963.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29502.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12963.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OnabotulinumtoxinA For Inj 100 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00023114501", "type": "NDC" }, { "code": "J0585", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.3167, "maximum": 25.6547, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2505.16, "10th_percentile": 2505.16, "90th_percentile": 2505.16, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.65, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.93 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE", "code_information": [ { "code": "86694", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.25, "discounted_cash": 14.0, "minimum": 13.9842, "maximum": 184.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 64.32, "10th_percentile": 64.32, "90th_percentile": 64.32, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVASC INTRA LITHOTRIP-STENT", "code_information": [ { "code": "C9765", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71019.1, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 71019.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Protamine Sulfate Inj 10 MG/ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323022901", "type": "NDC" }, { "code": "J2720", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.01, "maximum": 3.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 149.95, "10th_percentile": 149.95, "90th_percentile": 149.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.01 } ] } ] }, { "description": "HC ASSAY, BLD/SERUM CHOLESTEROL", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.0, "discounted_cash": 4.0, "minimum": 4.2273, "maximum": 52.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 4.35, "10th_percentile": 4.35, "90th_percentile": 4.35, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 32.29, "10th_percentile": 32.29, "90th_percentile": 32.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEXA,BONE DENSITY, 1 + SITE, APPENDICULR SKELTN", "code_information": [ { "code": "77081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 384.06, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 384.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 384.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 89.4, "10th_percentile": 89.4, "90th_percentile": 89.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 235.54, "10th_percentile": 235.54, "90th_percentile": 256.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOGRAM RENAL UNILAT", "code_information": [ { "code": "75831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10857.5, "discounted_cash": 3115.0, "minimum": 602.5821, "maximum": 10857.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10857.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10857.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10857.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 602.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine HCl Local Preservative Free (PF) Inj 2%", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323049504", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.13, "90th_percentile": 25.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.7, "10th_percentile": 15.7, "90th_percentile": 15.7, "count": "1 through 10" } ] } ] }, { "description": "HC CLSD TREAT METACARPAL FX W MANIP EA", "code_information": [ { "code": "26605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PRQ DRUG ELUTING COR REVASC T CABG S - C9604 - 48100196", "code_information": [ { "code": "C9604", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27935.9, "discounted_cash": 11390.0, "minimum": 8380.77, "maximum": 27935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COMPLETE CBC & AUTO DIFF WBC", "code_information": [ { "code": "85025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.81, "discounted_cash": 7.0, "minimum": 7.5509, "maximum": 102.7303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 71.2, "10th_percentile": 59.81, "90th_percentile": 71.2, "count": "234" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 9.44, "10th_percentile": 9.44, "90th_percentile": 9.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 60.04, "10th_percentile": 56.69, "90th_percentile": 82.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 34.73, "10th_percentile": 17.97, "90th_percentile": 71.2, "count": "132" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 78.32, "10th_percentile": 40.77, "90th_percentile": 82.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12029.0, "minimum": 9484.99, "maximum": 26091.042, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11585.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26091.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11585.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11585.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25180.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12029.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9484.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12029.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25180.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11585.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12029.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11585.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16058.59 } ] } ] }, { "description": "HC RMV PACER/ELECTRD,TRANSVEN EXTRCT", "code_information": [ { "code": "33244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8805.0, "discounted_cash": 3687.0, "minimum": 2641.5, "maximum": 8805.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8805.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8805.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8805.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4019.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6235.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17717.0, "minimum": 15773.71, "maximum": 45751.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39605.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 45751.08 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15773.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45751.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24376.5 } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC", "code_information": [ { "code": "351", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12642.0, "minimum": 10413.14, "maximum": 39410.4673, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12173.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27547.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12173.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12173.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37316.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12642.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10413.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12642.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37316.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12173.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12642.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12173.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16955.0 } ] } ] }, { "description": "HC (SUP SHELL C1722) AICD, SINGLE CHAMBER", "code_information": [ { "code": "C1722", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 39252.36, "10th_percentile": 39252.36, "90th_percentile": 39252.36, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4107) GRAFTJACKET", "code_information": [ { "code": "Q4107", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6254) ABSORPT DRG <=16 SQ IN W/BDR - A6254 - 27200143", "code_information": [ { "code": "A6254", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.6521, "maximum": 2.875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.65, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0623) SIO RIG PNL PELV/SAC PRE OTS", "code_information": [ { "code": "L0623", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 137.0, "minimum": 133.2629, "maximum": 231.9143, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 137.13, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.57, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 133.26, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 137.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 137.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 149.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 137.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fondaparinux Sodium Subcutaneous Inj 10 MG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55111068111", "type": "NDC" }, { "code": "J1652", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.849, "maximum": 1.849, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.85 } ] } ] }, { "description": "HC (SUP SHELL A5057) 1 PC OST POU W BUILT-IN CONV", "code_information": [ { "code": "A5057", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 13.0, "minimum": 13.2942, "maximum": 23.1356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.62, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3925) FO PIP DIP JNT/SPRNG PRE OTS", "code_information": [ { "code": "L3925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 58.0, "minimum": 57.0252, "maximum": 99.2396, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 58.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.28, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57.03, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOGENETICS 100-300", "code_information": [ { "code": "88275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1231.56, "discounted_cash": 51.0, "minimum": 49.7464, "maximum": 1073.9203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.18, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.75, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.57, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARC BLOOD TYPING, ABO", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.56, "discounted_cash": 131.0, "minimum": 15.6891, "maximum": 61.56, "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 13.37, "10th_percentile": 13.37, "90th_percentile": 13.37, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 33.1, "10th_percentile": 33.1, "90th_percentile": 39.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 61.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC FPVT ANGIOP UNI SF LES 1ST VSL", "code_information": [ { "code": "37263", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27547.8, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 26875.9169, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22124.32, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26875.92, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF SOMATOMEDIN", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 21.0, "minimum": 20.6605, "maximum": 222.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 163.2, "10th_percentile": 163.2, "90th_percentile": 163.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 129.95, "10th_percentile": 129.95, "90th_percentile": 129.95, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 139.86, "10th_percentile": 137.23, "90th_percentile": 139.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 95.03, "10th_percentile": 95.03, "90th_percentile": 95.03, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 179.52, "10th_percentile": 179.52, "90th_percentile": 179.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMV INDWELLING TUNNELED PLEURAL CATH W CUFF", "code_information": [ { "code": "32552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1843.75, "discounted_cash": 618.0, "minimum": 553.125, "maximum": 1843.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1843.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1843.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1843.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRLML BLLN ANGIOP OPEN/PERQ IMG S&I INIT ART", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18982.2, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 18982.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18982.2, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18982.2, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18982.2, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRACHEOTOMY TUBE CHANGE", "code_information": [ { "code": "31502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 818.75, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 818.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 818.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 818.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 818.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL E0973) W/CH ACCESS DET ADJ ARMREST", "code_information": [ { "code": "E0973", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 61.0, "minimum": 59.8143, "maximum": 104.0934, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.55, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.76, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.81, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 61.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 61.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 61.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 61.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 104.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ISLET CELL ANTIBODY", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.75, "discounted_cash": 23.0, "minimum": 22.9053, "maximum": 168.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 104.27, "10th_percentile": 104.27, "90th_percentile": 104.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14683.0, "minimum": 12146.93, "maximum": 32395.6092, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32395.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29392.76 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14683.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12146.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14683.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29392.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14683.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19938.95 } ] } ] }, { "description": "HC HTLV/HIV CONFIRMATORY TEST", "code_information": [ { "code": "86689", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.69, "discounted_cash": 19.0, "minimum": 18.8043, "maximum": 283.1297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.07, "10th_percentile": 156.07, "90th_percentile": 156.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 174.73, "10th_percentile": 174.73, "90th_percentile": 174.73, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC GROUP THERAPEUTIC PROCEDURES - G0239 - 42000022", "code_information": [ { "code": "G0239", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 36.0, "minimum": 36.85, "maximum": 135.0, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 135.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT FEMUR,DISTAL W MANIP", "code_information": [ { "code": "27510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2979.69, "discounted_cash": 1586.0, "minimum": 893.907, "maximum": 2979.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2979.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2979.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2979.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT", "code_information": [ { "code": "008", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43673.0, "minimum": 37659.65, "maximum": 121209.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41948.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 101274.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 41948.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 41948.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 121208.6 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 43673.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37659.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43673.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 121209.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41948.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 43673.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41948.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62332.57 } ] } ] }, { "description": "HC TRIIODOTHYRONINE T3 REVERSE", "code_information": [ { "code": "84482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.31, "discounted_cash": 15.0, "minimum": 15.3156, "maximum": 187.7503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 115.75, "10th_percentile": 115.75, "90th_percentile": 115.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERCUT PULMONARY VALVULOPLASTY", "code_information": [ { "code": "92990", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22195.3, "discounted_cash": 11390.0, "minimum": 6658.59, "maximum": 22195.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22195.3, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22195.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22195.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hydroxyzine HCl IM Soln 25 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00517420101", "type": "NDC" }, { "code": "J3410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 38.184, "maximum": 38.184, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.18 } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC", "code_information": [ { "code": "542", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14482.0, "minimum": 12908.97, "maximum": 38094.8065, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31920.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36021.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14482.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12908.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14482.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36021.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14482.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13939.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19646.45 } ] } ] }, { "description": "HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT", "code_information": [ { "code": "69210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 343.13, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 299.2094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4333) URINARY CATH ANCHOR DEVICE", "code_information": [ { "code": "A4333", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.0709, "maximum": 5.3442, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.84, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.07, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4426) OST PCH DRAIN 2 PIECE SYSTEM", "code_information": [ { "code": "A4426", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.7803, "maximum": 6.5788, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTHER PROLONG INFUSE W/PUMP", "code_information": [ { "code": "96416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1583.75, "discounted_cash": 325.0, "minimum": 325.91, "maximum": 1559.7075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1283.96, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1559.71, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1247.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 551.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ceftazidime For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409508413", "type": "NDC" }, { "code": "J0713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.44, "maximum": 3.44, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.44 } ] } ] }, { "description": "HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT - 98960 - 42998960", "code_information": [ { "code": "98960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.69, "minimum": 28.407, "maximum": 94.69, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.69 } ] } ] }, { "description": "HC REVSC EVASC TPVT ST PLMT UNI SF LES 1ST VSL", "code_information": [ { "code": "37284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OCCUP THRP RE-EVAL, 30 MIN", "code_information": [ { "code": "97168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.06, "discounted_cash": 65.0, "minimum": 63.614, "maximum": 308.7403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.51, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.61, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 110.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Chlorpromazine HCl Inj 25 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641139731", "type": "NDC" }, { "code": "J3230", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 62.436, "maximum": 62.436, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.44 } ] } ] }, { "description": "Iopamidol Inj 41%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00270141111", "type": "NDC" }, { "code": "Q9966", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "PSYCHOSES", "code_information": [ { "code": "885", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11671.0, "minimum": 9756.31, "maximum": 35083.8101, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11241.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25239.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11241.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11241.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11672.54 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11671.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9756.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11671.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11672.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11241.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11671.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11241.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15534.76 } ] } ] }, { "description": "HC ASSAY, RBC CHOLINESTERASE", "code_information": [ { "code": "82482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.75, "discounted_cash": 9.0, "minimum": 9.5334, "maximum": 116.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.53, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT INDWEL CATH PLEURAL DRAIN WO IMG", "code_information": [ { "code": "32556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3069.38, "discounted_cash": 1893.0, "minimum": 920.814, "maximum": 3069.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3069.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3069.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3069.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2063.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3069.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6403) STERILE GAUZE>16 <= 48 SQ IN - A6403 - RU272060", "code_information": [ { "code": "A6403", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "655", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17145.0, "minimum": 14377.68, "maximum": 40865.5868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16494.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38246.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16494.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16494.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36223.66 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17145.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14377.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17145.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36223.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16494.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17145.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16494.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23540.15 } ] } ] }, { "description": "HC (SUP SHELL L8440) SHRINKER BELOW KNEE", "code_information": [ { "code": "L8440", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 57.0, "minimum": 55.9562, "maximum": 97.3793, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.94, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.96, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 97.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "418", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13913.0, "minimum": 11478.33, "maximum": 39967.7831, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 35980.17, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 25518.19, "10th_percentile": 25518.19, "90th_percentile": 25518.19, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13392.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30566.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13392.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 35068.06, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 30129.81, "10th_percentile": 30129.81, "90th_percentile": 30129.81, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13392.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38421.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13913.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11478.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13913.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38421.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 39967.78, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 52066.84, "10th_percentile": 52066.84, "90th_percentile": 52066.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13392.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13913.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13392.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18813.43 } ] } ] }, { "description": "HC LEPTOSPIRA", "code_information": [ { "code": "86720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 309.06, "discounted_cash": 16.0, "minimum": 15.7432, "maximum": 269.5003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.74, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "168", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11440.0, "minimum": 9370.79, "maximum": 42639.8146, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11019.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24690.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11019.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11019.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31228.1 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11440.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9370.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11440.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31228.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11019.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11440.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11019.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15196.66 } ] } ] }, { "description": "HC (SUP SHELL A4615) CANNULA NASAL - A4615 - 27100065", "code_information": [ { "code": "A4615", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.0107, "maximum": 1.7588, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Penicillin G Potassium For Inj 5000000 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00049052084", "type": "NDC" }, { "code": "J2540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.677, "maximum": 1.677, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.68 } ] } ] }, { "description": "HC NERVE TEASING PREPARATIONS", "code_information": [ { "code": "88362", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 965.0, "discounted_cash": 794.0, "minimum": 289.5, "maximum": 965.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 965.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 790.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 866.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 965.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 965.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 965.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bumetanide Inj 0.25 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "72205010201", "type": "NDC" }, { "code": "J1939", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.2255, "maximum": 1.2255, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.23 } ] } ] }, { "description": "HC VENT MANAGEMENT, INPATIENT, INITIAL DAY", "code_information": [ { "code": "94002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1044.38, "discounted_cash": 609.0, "minimum": 313.314, "maximum": 1044.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1044.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1044.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1044.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 664.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1030.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6212) FOAM DRG <=16 SQ IN W/BORDER - A6212 - RU272044", "code_information": [ { "code": "A6212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 13.0, "minimum": 13.4497, "maximum": 23.4062, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OSTEOMYELITIS WITHOUT CCMCC", "code_information": [ { "code": "541", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7036.0, "minimum": 6055.47, "maximum": 16260.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6794.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14228.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6794.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6794.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16260.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7036.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6055.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7036.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16260.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6794.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7036.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6794.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8757.21 } ] } ] }, { "description": "HC (SUP SHELL A4648) IMPLANTABLE TISSUE MARKER - A4648 - 27800001", "code_information": [ { "code": "A4648", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 88.87, "10th_percentile": 88.87, "90th_percentile": 1799.0, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 265.99, "10th_percentile": 253.43, "90th_percentile": 265.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 267.35, "10th_percentile": 267.35, "90th_percentile": 1723.89, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 516.38, "10th_percentile": 516.38, "90th_percentile": 516.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 304.11, "10th_percentile": 249.91, "90th_percentile": 2098.25, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L1831) KNEE ORTH POS LOCKING JOINT", "code_information": [ { "code": "L1831", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 353.0, "minimum": 343.0843, "maximum": 597.0612, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 428.84, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 343.08, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 384.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 597.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4187) EPICORD 1 SQ CM", "code_information": [ { "code": "Q4187", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 531.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "091", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14404.0, "minimum": 12616.89, "maximum": 52353.4831, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13864.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31734.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13864.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 45791.29, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16524.93, "10th_percentile": 16524.93, "90th_percentile": 16524.93, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13864.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31237.84 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14404.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12616.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14404.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31237.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13864.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14404.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13864.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19531.89 } ] } ] }, { "description": "HC REMV F.B.,EYE,SUPERF CONJUNC", "code_information": [ { "code": "65205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.75, "discounted_cash": 131.0, "minimum": 119.625, "maximum": 398.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 398.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 398.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 398.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CCMCC", "code_information": [ { "code": "749", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20575.0, "minimum": 17916.55, "maximum": 46396.1212, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19785.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 46396.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19785.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19785.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32313.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20575.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17916.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20575.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32313.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19785.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20575.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19785.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28556.03 } ] } ] }, { "description": "Acetaminophen IV Soln 10 MG/ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "63323043441", "type": "NDC" }, { "code": "J0131", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 44.69, "10th_percentile": 44.69, "90th_percentile": 44.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 55.02, "10th_percentile": 55.02, "90th_percentile": 55.02, "count": "1 through 10" } ] } ] }, { "description": "Insulin NPH Isophane & Regular Human Inj 100 Unit/ML (70-30)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00002871501", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC INSERT TUNNELED CTR VAD W/SUBQ PORT < 5YR", "code_information": [ { "code": "36560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7907.5, "discounted_cash": 3115.0, "minimum": 2372.25, "maximum": 7907.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7907.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7907.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7907.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8499.39, "maximum": 8499.39, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8499.39 } ] } ] }, { "description": "HC ST BEHAVI QUALT ANALYSIS VOICE & RESONANCE, 15 MIN", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 453.13, "discounted_cash": 105.0, "minimum": 95.0, "maximum": 395.1294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.62, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.3, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.64, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 105.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 105.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 105.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 178.62, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT ELBOW DISLOC WO ANES", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 484.69, "discounted_cash": 243.0, "minimum": 145.407, "maximum": 484.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 484.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 484.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY KNEE 3 VIEW", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 564.38, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 492.1394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 340.8, "10th_percentile": 286.27, "90th_percentile": 340.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 331.17, "10th_percentile": 331.17, "90th_percentile": 344.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 125.03, "10th_percentile": 125.03, "90th_percentile": 125.03, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 374.88, "10th_percentile": 374.88, "90th_percentile": 393.71, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "422", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11691.0, "minimum": 10170.2, "maximum": 30265.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11261.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25288.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11261.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11261.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30265.62 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11691.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10170.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11691.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30265.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11261.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11691.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11261.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15564.79 } ] } ] }, { "description": "HC HLA TYPING, A,B,OR C /SINGLE", "code_information": [ { "code": "86812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.94, "discounted_cash": 25.0, "minimum": 25.0822, "maximum": 297.2997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 205.8, "10th_percentile": 205.8, "90th_percentile": 205.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 150.0, "10th_percentile": 150.0, "90th_percentile": 150.0, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 115.37, "10th_percentile": 115.37, "90th_percentile": 115.37, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 226.38, "10th_percentile": 226.38, "90th_percentile": 237.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY ELBOW 2 VW", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 393.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 393.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 84.13, "10th_percentile": 84.13, "90th_percentile": 84.13, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 393.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 261.36, "10th_percentile": 261.36, "90th_percentile": 261.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5112) URINARY LEG BAG", "code_information": [ { "code": "A5112", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 42.0, "minimum": 41.4667, "maximum": 72.1635, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.67, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.83, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.47, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 42.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 42.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<", "code_information": [ { "code": "14060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7844.38, "discounted_cash": 2035.0, "minimum": 2035.84, "maximum": 7844.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7844.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7844.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7794.62, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ", "code_information": [ { "code": "27267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5379.06, "discounted_cash": 3228.0, "minimum": 1613.718, "maximum": 5379.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5379.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5379.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5379.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5379.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HERPES SIMPLEX TEST, TYPE 2", "code_information": [ { "code": "86696", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.06, "discounted_cash": 19.0, "minimum": 18.8043, "maximum": 273.8603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 86.49, "10th_percentile": 86.49, "90th_percentile": 189.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 162.49, "10th_percentile": 162.49, "90th_percentile": 162.49, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 208.56, "10th_percentile": 208.56, "90th_percentile": 221.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THAW PLASMA FRESH FROZEN EA UNIT - P9022 - 30200150", "code_information": [ { "code": "P9022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1036.88, "discounted_cash": 366.0, "minimum": 311.064, "maximum": 2019.4997, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1036.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1036.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 399.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 620.28, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1036.88, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "HC INTRINSIC FACTOR ANTIBODY", "code_information": [ { "code": "86340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.69, "discounted_cash": 15.0, "minimum": 14.6547, "maximum": 248.2497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.32, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 153.21, "10th_percentile": 153.21, "90th_percentile": 153.21, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF METANEPHRINES", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1052.19, "discounted_cash": 16.0, "minimum": 16.4623, "maximum": 917.5097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 673.4, "10th_percentile": 673.4, "90th_percentile": 673.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 162.44, "10th_percentile": 162.44, "90th_percentile": 162.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 75.72, "10th_percentile": 75.72, "90th_percentile": 75.72, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 740.74, "10th_percentile": 740.74, "90th_percentile": 740.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1932) AFO RIG ANT TIB PREFAB TCF/=", "code_information": [ { "code": "L1932", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1070.0, "minimum": 1040.205, "maximum": 1810.2436, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1070.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1070.39, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1300.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1070.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1040.21, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1070.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1070.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1070.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1166.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1070.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1070.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1070.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1070.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1070.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1810.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CONTRAST BATH THERAPY EA 15 MIN", "code_information": [ { "code": "97034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.69, "discounted_cash": 13.0, "minimum": 12.993, "maximum": 113.0897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC WBC ANTIBODY IDENTIFICATION", "code_information": [ { "code": "86021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.25, "discounted_cash": 15.0, "minimum": 14.6256, "maximum": 66.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 44.0, "10th_percentile": 44.0, "90th_percentile": 46.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF THYROID STIM IMMUNOGLOBULINS (TSI)", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 550.63, "discounted_cash": 50.0, "minimum": 49.4257, "maximum": 480.1494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 352.4, "10th_percentile": 352.4, "90th_percentile": 352.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.78, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.43, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 296.32, "10th_percentile": 296.32, "90th_percentile": 302.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 387.64, "10th_percentile": 387.64, "90th_percentile": 387.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRANSFUSION PROCEDURE", "code_information": [ { "code": "86999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1776.56, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 1549.1603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEMODIALYSIS W SING EVAL - G0257 - 80100001", "code_information": [ { "code": "G0257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3368.75, "discounted_cash": 677.0, "minimum": 677.19, "maximum": 3240.8282, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2667.86, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3240.83, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2592.76, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 738.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1145.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VARICELLA-ZOSTER", "code_information": [ { "code": "86787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.94, "discounted_cash": 12.0, "minimum": 12.5168, "maximum": 166.4997, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 57.57, "10th_percentile": 57.57, "90th_percentile": 64.85, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 133.2, "10th_percentile": 67.58, "90th_percentile": 133.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 57.57, "10th_percentile": 57.57, "90th_percentile": 57.57, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 97.3, "10th_percentile": 97.3, "90th_percentile": 97.3, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 102.75, "10th_percentile": 98.73, "90th_percentile": 102.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.58 } ] } ] }, { "description": "HC INSERT INDWEL CATH PLEURAL DRAIN W IMG", "code_information": [ { "code": "32557", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4660.63, "discounted_cash": 1553.0, "minimum": 1398.189, "maximum": 4660.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4660.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4660.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4660.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF LACTIC ACID", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.75, "discounted_cash": 11.0, "minimum": 11.2437, "maximum": 151.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 93.41, "10th_percentile": 93.41, "90th_percentile": 111.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.24, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 95.3, "10th_percentile": 93.51, "90th_percentile": 95.3, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 51.72, "10th_percentile": 51.72, "90th_percentile": 93.41, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 122.32, "10th_percentile": 60.71, "90th_percentile": 244.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LACTOFERRIN, FECAL, QUAN", "code_information": [ { "code": "83631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 613.13, "discounted_cash": 19.0, "minimum": 19.0764, "maximum": 534.6494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [ { "code": "229", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25001.0, "minimum": 21499.73, "maximum": 108068.282, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24032.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 56910.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24032.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24032.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 71227.65 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25001.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21499.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25001.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71227.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24032.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25001.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24032.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35027.73 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CCMCC", "code_information": [ { "code": "715", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18063.0, "minimum": 15630.44, "maximum": 53567.9715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17375.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 40427.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17375.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17375.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48385.24 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15630.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48385.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17375.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18063.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17375.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24882.53 } ] } ] }, { "description": "HC MONONUCLEAR CELL ANTIGEN", "code_information": [ { "code": "86356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 384.06, "discounted_cash": 26.0, "minimum": 26.0248, "maximum": 334.9003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.02, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URIC ACID, BLOOD", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.63, "discounted_cash": 4.0, "minimum": 4.3925, "maximum": 70.3094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 62.2, "10th_percentile": 52.25, "90th_percentile": 62.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.39, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 49.53, "10th_percentile": 49.53, "90th_percentile": 99.06, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 53.31, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 20.2, "10th_percentile": 20.2, "90th_percentile": 20.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 23.72, "10th_percentile": 23.72, "90th_percentile": 23.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRAUMATIC INJURY WITH MCC", "code_information": [ { "code": "913", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13479.0, "minimum": 11200.79, "maximum": 65013.3814, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12976.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29536.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12976.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12976.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 35350.8 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11200.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35350.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12976.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13479.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12976.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18179.5 } ] } ] }, { "description": "Diphenhydramine HCl Cap 25 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68094001859", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CLSD TREAT LUNATE DISLOC W MANIP", "code_information": [ { "code": "25690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8391.88, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 7593.0395, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6250.61, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7593.04, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6074.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PHYSICAL PERFORMANCE TEST EA 15 MIN", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.81, "discounted_cash": 32.0, "minimum": 31.2337, "maximum": 181.2103, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.36, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.23, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8501) TRACHEOSTOMY SPEAKING VALVE", "code_information": [ { "code": "L8501", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 197.0, "minimum": 191.6195, "maximum": 333.4708, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 197.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 239.51, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 191.62, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC I&D ARM,DEEP ABSC/HEMATOMA", "code_information": [ { "code": "23930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10337.5, "discounted_cash": 2866.0, "minimum": 2866.09, "maximum": 10337.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10337.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10337.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10337.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4847.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATH PLC/COR ANGIO RS/I R&L HRT CATH L VENTRIC", "code_information": [ { "code": "93460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 10128.55, "10th_percentile": 10128.55, "90th_percentile": 10128.55, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC", "code_information": [ { "code": "939", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28644.0, "minimum": 21968.3, "maximum": 78471.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27527.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 65566.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27527.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27527.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 78471.61 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28644.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21968.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28644.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78471.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27527.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28644.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27527.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40355.02 } ] } ] }, { "description": "HC (SUP SHELL Q4239) AMNIO-MAXX OR LITE PER SQ CM", "code_information": [ { "code": "Q4239", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 5052.328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5052.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRIM NAIL(S)", "code_information": [ { "code": "11719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 58.0, "minimum": 42.0, "maximum": 140.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7136.0, "minimum": 5186.15, "maximum": 15970.8631, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6890.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14466.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6890.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6890.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13989.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7136.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5186.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7136.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13989.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6890.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7136.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6890.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8904.02 } ] } ] }, { "description": "HC ASSAY OF ASCORBIC ACID", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.81, "discounted_cash": 9.0, "minimum": 9.6111, "maximum": 150.6903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 110.6, "10th_percentile": 110.6, "90th_percentile": 110.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1771) REP DEV, URINARY, W/SLING", "code_information": [ { "code": "C1771", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 2991.44, "10th_percentile": 2991.44, "90th_percentile": 2991.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2921.32, "10th_percentile": 2921.32, "90th_percentile": 3105.08, "count": "1 through 10" } ] } ] }, { "description": "HC XRAY SPINE, COMPLETE, =>6 VW", "code_information": [ { "code": "72084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.19, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 677.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 677.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3929) HFO NONTORSION JNTS PRE CST", "code_information": [ { "code": "L3929", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 87.0, "minimum": 85.4212, "maximum": 148.6565, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.9, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.77, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.42, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 87.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 87.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 87.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 87.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRUG SCREEN MULTIP CLASS", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.13, "discounted_cash": 62.0, "minimum": 60.3877, "maximum": 323.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 163.8, "10th_percentile": 154.0, "90th_percentile": 277.77, "count": "21" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60.39, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 470.66, "10th_percentile": 470.66, "90th_percentile": 470.66, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 173.89, "10th_percentile": 99.58, "90th_percentile": 333.49, "count": "51" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 323.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 258.5, "10th_percentile": 195.0, "90th_percentile": 258.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 134.29, "10th_percentile": 134.29, "90th_percentile": 470.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 105.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MR-STAPH DNA AMP PROBE", "code_information": [ { "code": "87641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.0, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 231.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 134.4, "10th_percentile": 134.4, "90th_percentile": 160.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 156.85, "10th_percentile": 156.85, "90th_percentile": 156.85, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 184.86, "10th_percentile": 176.0, "90th_percentile": 184.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SURG PATH,LEVEL VI", "code_information": [ { "code": "88309", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 848.75, "discounted_cash": 794.0, "minimum": 254.625, "maximum": 848.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 848.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 848.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 848.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 848.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 679.0, "10th_percentile": 679.0, "90th_percentile": 679.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 848.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 848.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Chlorothiazide Sodium For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "25021030520", "type": "NDC" }, { "code": "J1205", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 69.832, "maximum": 69.832, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.83 } ] } ] }, { "description": "HC VENOGRAM EXTREM UNILAT", "code_information": [ { "code": "75820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3313.44, "discounted_cash": 1553.0, "minimum": 520.6887, "maximum": 3313.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3313.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3313.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3313.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 520.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1951.57, "10th_percentile": 1951.57, "90th_percentile": 1951.57, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4320) IRRIGATION TRAY", "code_information": [ { "code": "A4320", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.3954, "maximum": 12.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PULMONARY STRESS TESTING", "code_information": [ { "code": "94618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 506.88, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 506.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 506.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 506.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8823.0, "minimum": 7056.99, "maximum": 26417.2313, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8508.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18472.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8508.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8508.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21139.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8823.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7056.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8823.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21139.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8508.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8823.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8508.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11369.69 } ] } ] }, { "description": "HC PRIM PERC MECH THROMBECTOMY, ARTERIAL", "code_information": [ { "code": "37184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14669.4, "discounted_cash": 18087.0, "minimum": 4400.82, "maximum": 14669.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14669.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "628", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29391.0, "minimum": 27309.49, "maximum": 84252.6846, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28245.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 67342.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28245.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 73924.0, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 85996.32, "10th_percentile": 85996.32, "90th_percentile": 85996.32, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28245.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 52963.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 29391.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27309.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29391.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52963.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28245.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 29391.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28245.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41448.28 } ] } ] }, { "description": "Tocilizumab-aazg IV Inj 400 MG/20ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "65219059420", "type": "NDC" }, { "code": "Q5135", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.2954, "maximum": 17.4761, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6021) COLLAGEN DRESSING <=16 SQ IN - A6021 - 27200109", "code_information": [ { "code": "A6021", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 29.0, "minimum": 29.1248, "maximum": 50.6853, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.4, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT HEART CONTRAST EVAL CARDIAC STRUCT/MORPH", "code_information": [ { "code": "75572", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1814.06, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1647.3337, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1336.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE", "code_information": [ { "code": "37244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34679.1, "discounted_cash": 11390.0, "minimum": 10403.73, "maximum": 34679.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34679.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34679.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34679.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Liposome Inj 1.3% (13.3 MG/ML)", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "65250026620", "type": "NDC" }, { "code": "J0666", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.409, "maximum": 5.5509, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1575.01, "10th_percentile": 1575.01, "90th_percentile": 1575.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.55, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.43, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PRIMIDONE", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.63, "discounted_cash": 16.0, "minimum": 16.1222, "maximum": 148.7894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLOT INHIB PROTEIN S,FREE", "code_information": [ { "code": "85306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 620.63, "discounted_cash": 15.0, "minimum": 14.888, "maximum": 541.1894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.61, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY GROWTH HORMONE (HGH)", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 281.88, "discounted_cash": 16.0, "minimum": 16.1999, "maximum": 245.7994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.25, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6466.0, "minimum": 4820.71, "maximum": 28664.772, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6247.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12874.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6247.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 25071.81, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 26151.01, "10th_percentile": 26151.01, "90th_percentile": 26151.01, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6247.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13139.65 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6466.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4820.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6466.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13139.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6247.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6466.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6247.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7924.2 } ] } ] }, { "description": "HC THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASURE", "code_information": [ { "code": "78012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 621.88, "discounted_cash": 394.0, "minimum": 186.564, "maximum": 621.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 621.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 621.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 621.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 621.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 621.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEMATOCRIT", "code_information": [ { "code": "85014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.75, "discounted_cash": 2.0, "minimum": 2.3032, "maximum": 38.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.01, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 22.18, "10th_percentile": 22.18, "90th_percentile": 26.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.3, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 22.3, "10th_percentile": 22.3, "90th_percentile": 22.3, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 10.59, "10th_percentile": 10.59, "90th_percentile": 10.59, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 29.04, "10th_percentile": 29.04, "90th_percentile": 29.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7446.0, "minimum": 6470.06, "maximum": 15202.1564, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7187.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15202.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7187.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7187.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 7766.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7446.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6470.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7446.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7766.11 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7187.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7446.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7187.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9356.67 } ] } ] }, { "description": "HC SLCTV CATH CAROTD/INNOM ART ANGIO INTRCRANL ART", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9181.88, "discounted_cash": 5490.0, "minimum": 2754.564, "maximum": 9181.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9181.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRA SPINAL CANAL W CONTRAST - C8931 - 61800010", "code_information": [ { "code": "C8931", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2284.38, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1991.9794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "331", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13847.0, "minimum": 11427.12, "maximum": 44396.982, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30409.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38370.74 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13847.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11427.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13847.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38370.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 44396.98, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 31628.25, "10th_percentile": 31628.25, "90th_percentile": 31628.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13847.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13329.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18716.68 } ] } ] }, { "description": "HC CLSD TREAT RADIAL SHAFT FX & SITAL DISLOC", "code_information": [ { "code": "25520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5742.5, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 5742.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5742.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5742.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5742.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PHOSPHOLIPID NEUTRALIZATION,PLATELET", "code_information": [ { "code": "85597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.19, "discounted_cash": 17.0, "minimum": 17.473, "maximum": 180.6697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL E0971) WHEELCHAIR ANTI-TIPPING DEVI", "code_information": [ { "code": "E0971", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 36.0, "minimum": 35.8789, "maximum": 62.4391, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.85, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35.88, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4110) PRIMATRIX", "code_information": [ { "code": "Q4110", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MEAS,POST-VOID RES,US,NON-IMAGING", "code_information": [ { "code": "51798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 344.69, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 300.5697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1776) JOINT DEVICE", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 10806.43, "10th_percentile": 3065.0, "90th_percentile": 21388.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 3748.43, "10th_percentile": 3748.43, "90th_percentile": 3748.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 9845.1, "10th_percentile": 5008.08, "90th_percentile": 10838.52, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY RIBS 3 VW BILAT", "code_information": [ { "code": "71110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 688.75, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 600.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT RADIAL HEAD/NECK FX WO MANIP", "code_information": [ { "code": "24650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C9355 )NEUROMATRIX NERVE CUFF, CM", "code_information": [ { "code": "C9355", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 391.816, "maximum": 391.816, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 391.82 } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CCMCC", "code_information": [ { "code": "066", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6253.0, "minimum": 4763.95, "maximum": 20502.1503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 18456.64, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 14409.55, "10th_percentile": 14409.55, "90th_percentile": 14409.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6042.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12367.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6042.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 17445.64, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 20231.53, "10th_percentile": 20231.53, "90th_percentile": 20231.53, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6042.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17024.65 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6253.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4763.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6253.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17024.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6042.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6253.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6042.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7611.68 } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "627", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11150.0, "minimum": 8768.63, "maximum": 29351.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10741.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24002.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10741.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10741.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29351.84 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8768.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29351.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10741.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11150.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10741.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14772.93 } ] } ] }, { "description": "PLEURAL EFFUSION WITHOUT CCMCC", "code_information": [ { "code": "188", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6502.0, "minimum": 3668.9284, "maximum": 12959.6892, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6281.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12959.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6281.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6281.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11898.55 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6502.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5081.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6502.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11898.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6281.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6502.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6281.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7976.47 } ] } ] }, { "description": "HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS", "code_information": [ { "code": "49441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3443.44, "discounted_cash": 1893.0, "minimum": 1033.032, "maximum": 3443.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3443.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3443.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3443.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2063.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1893.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3202.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine HCl (Cardiac) IV Soln 100 MG/5ML (2%)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "76329339001", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.13, "90th_percentile": 25.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.7, "10th_percentile": 15.7, "90th_percentile": 15.7, "count": "1 through 10" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11814.0, "minimum": 9712.7, "maximum": 25579.6655, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11378.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25579.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11378.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11378.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12140.14 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11814.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9712.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11814.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12140.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11378.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11814.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11378.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15743.85 } ] } ] }, { "description": "HC ASSAY OF BLOOD LIPOPROTEIN,LDL CHOLEST", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.75, "discounted_cash": 10.0, "minimum": 10.2039, "maximum": 112.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 83.25, "10th_percentile": 70.62, "90th_percentile": 84.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 46.94, "10th_percentile": 46.94, "90th_percentile": 46.94, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 107.91, "10th_percentile": 55.1, "90th_percentile": 108.9, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6252) ABSORPT DRG >16 <=48 W/O BDR - A6252 - 27200141", "code_information": [ { "code": "A6252", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.5092, "maximum": 7.8472, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.64, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH MCC", "code_information": [ { "code": "662", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24331.0, "minimum": 21591.78, "maximum": 66210.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23390.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 55320.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23390.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23390.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 66210.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24331.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21591.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24331.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66210.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23390.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24331.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23390.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34049.02 } ] } ] }, { "description": "HC ANGIOTENSIN I ENZYME TEST", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.69, "discounted_cash": 14.0, "minimum": 14.1883, "maximum": 243.8897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 65.26, "10th_percentile": 65.26, "90th_percentile": 65.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.73, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 142.53, "10th_percentile": 142.53, "90th_percentile": 142.53, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 153.4, "10th_percentile": 150.52, "90th_percentile": 153.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 195.11, "10th_percentile": 195.11, "90th_percentile": 195.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL", "code_information": [ { "code": "35372", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12129.4, "discounted_cash": 5490.0, "minimum": 3638.82, "maximum": 12129.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12129.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12129.4, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12129.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3908) WHO COCK-UP NONMOLDE PRE OTS", "code_information": [ { "code": "L3908", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 89.0, "minimum": 87.2871, "maximum": 151.9036, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.1, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.29, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND CPLX FACE/HND/FT/GENT 2.6-7.5 CM", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1836.25, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 1836.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3905) WHO W/NONTORSION JNT(S) CF", "code_information": [ { "code": "L3905", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1082.0, "minimum": 1052.0901, "maximum": 1830.9269, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1082.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1082.62, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1315.06, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1082.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1052.09, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1082.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1082.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1082.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1180.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1082.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1082.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1082.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1082.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1082.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1830.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "URETHRAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "672", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9258.0, "minimum": 7574.7, "maximum": 23345.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8925.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19506.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8925.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8925.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23345.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9258.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7574.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9258.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23345.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8925.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9258.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8925.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12005.85 } ] } ] }, { "description": "HC DOPPLER MID CEREBRAL ART", "code_information": [ { "code": "76821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 516.56, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 491.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ", "code_information": [ { "code": "87535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 970.0, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 845.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 466.28, "10th_percentile": 466.28, "90th_percentile": 466.28, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L4398) FOOT DROP SPLINT PRE OTS", "code_information": [ { "code": "L4398", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 96.0, "minimum": 94.08, "maximum": 163.7251, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.81, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.6, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.08, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 96.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 96.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 96.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163.73, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BX BREAST W DEVICE US GUIDE 1ST LESION", "code_information": [ { "code": "19083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5091.25, "discounted_cash": 1629.0, "minimum": 1527.375, "maximum": 5091.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 3197.31, "10th_percentile": 3197.31, "90th_percentile": 3197.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5091.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5091.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5091.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 7246.67, "10th_percentile": 7246.67, "90th_percentile": 7246.67, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 3106.48, "10th_percentile": 3106.48, "90th_percentile": 3106.48, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 3225.82, "10th_percentile": 3225.82, "90th_percentile": 3225.82, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3551.66, "10th_percentile": 3551.66, "90th_percentile": 3584.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT ANGIO, ABD, COMBO,INCL IMAGE PROC", "code_information": [ { "code": "74175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2355.0, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2053.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1436.93, "10th_percentile": 1436.93, "90th_percentile": 1436.93, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2009.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC", "code_information": [ { "code": "492", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28971.0, "minimum": 24579.03, "maximum": 78541.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27842.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 66345.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27842.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27842.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 78541.75 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28971.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24579.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28971.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78541.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27842.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28971.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27842.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40834.36 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5930.0, "minimum": 4479.48, "maximum": 15835.9909, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5930.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10752.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5733.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5930.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5733.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7140.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5733.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11600.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5733.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5733.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10752.92 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5930.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4479.48 } ] } ] }, { "description": "HC ASPIRATION AND/OR INJECTION THYROID CYST", "code_information": [ { "code": "60300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.56, "discounted_cash": 698.0, "minimum": 10.968, "maximum": 36.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL V2632) POSTERIOR CHAMBER INTRAOCULAR LENS", "code_information": [ { "code": "V2632", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 145.0, "minimum": 141.6204, "maximum": 246.4586, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.02, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.62, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 158.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.46, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN,SOFT TISSUE NECK,W/O CONTRAST", "code_information": [ { "code": "70490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1630.94, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1422.1797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 821.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOGLOBULIN ASSAY, PLATELET", "code_information": [ { "code": "86023", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 848.44, "discounted_cash": 12.0, "minimum": 12.1086, "maximum": 739.8397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY URETHROCYSTOGRAM & VOIDING", "code_information": [ { "code": "74455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 970.31, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 970.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 970.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 778.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TEAEC W/GRAFT POPLITEAL ARTERY", "code_information": [ { "code": "35303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11003.1, "minimum": 3300.93, "maximum": 11003.1, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11003.1 } ] } ] }, { "description": "HC X-RAY BLADDER W CONTRAST", "code_information": [ { "code": "74430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 816.88, "discounted_cash": 344.0, "minimum": 231.0866, "maximum": 816.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 816.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 816.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 816.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR", "code_information": [ { "code": "35860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12993.1, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 12993.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12273.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12993.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ PARAVERT F JNT C/T 1 LEV", "code_information": [ { "code": "64490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3721.88, "discounted_cash": 872.0, "minimum": 872.7, "maximum": 3721.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3438.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3721.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3341.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15987.0, "minimum": 15105.8, "maximum": 41237.5078, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15383.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35494.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15383.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15383.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29466.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15987.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15105.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15987.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29466.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15383.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15987.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15383.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21846.32 } ] } ] }, { "description": "HC IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION", "code_information": [ { "code": "87341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.31, "discounted_cash": 10.0, "minimum": 10.0387, "maximum": 152.8703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.55, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT ANGIO AORTOBIFEMORAL, COMBO", "code_information": [ { "code": "75635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2311.56, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2311.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTINUCLEAR ANTIBODIES", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.94, "discounted_cash": 12.0, "minimum": 11.7491, "maximum": 166.4997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 96.77, "10th_percentile": 96.77, "90th_percentile": 115.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 97.3, "10th_percentile": 91.73, "90th_percentile": 194.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 102.75, "10th_percentile": 98.73, "90th_percentile": 102.75, "count": "20" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 54.04, "10th_percentile": 54.04, "90th_percentile": 54.04, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 126.72, "10th_percentile": 63.44, "90th_percentile": 133.2, "count": "47" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Meropenem IV For Soln 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55150020830", "type": "NDC" }, { "code": "J2185", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC GALECTIC-3 LEVEL", "code_information": [ { "code": "82777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.13, "discounted_cash": 44.0, "minimum": 43.0022, "maximum": 321.0094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.0, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 74.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ALLERGEN SPEC IGE QUANT,EACH", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.31, "discounted_cash": 5.0, "minimum": 5.0728, "maximum": 52.5903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 595.4, "10th_percentile": 595.4, "90th_percentile": 595.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 460.23, "10th_percentile": 26.51, "90th_percentile": 1254.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.33, "10th_percentile": 23.33, "90th_percentile": 350.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1255.03, "10th_percentile": 27.39, "90th_percentile": 1592.71, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTHER, IV INFUSE, EACH SEQU INFUS", "code_information": [ { "code": "96417", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 452.81, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 394.8503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 231.84, "10th_percentile": 231.84, "90th_percentile": 463.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 279.87, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.99, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 264.48, "10th_percentile": 264.48, "90th_percentile": 277.7, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 247.97, "10th_percentile": 214.27, "90th_percentile": 284.37, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 555.4, "10th_percentile": 303.6, "90th_percentile": 555.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4001) CAST SUP BODY CAST PLASTER", "code_information": [ { "code": "Q4001", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 62.0, "minimum": 60.6014, "maximum": 105.4632, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.36, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.75, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 62.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 62.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 62.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 105.46, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CCMCC", "code_information": [ { "code": "807", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6175.0, "minimum": 4410.96, "maximum": 12182.6861, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 9567.77, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7777.47, "10th_percentile": 3772.01, "90th_percentile": 14166.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5968.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12182.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5968.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 9043.67, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7188.28, "10th_percentile": 7188.28, "90th_percentile": 15070.0, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 9295.97, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5543.93, "10th_percentile": 5543.93, "90th_percentile": 7974.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 9325.22, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8498.22, "10th_percentile": 5484.45, "90th_percentile": 31678.71, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5968.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8409.06 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 10603.77, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9777.62, "10th_percentile": 9050.22, "90th_percentile": 10945.85, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6175.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4410.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6175.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8409.06 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 10628.15, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7803.56, "10th_percentile": 5457.23, "90th_percentile": 14231.66, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5968.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6175.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5968.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7498.24 } ] } ] }, { "description": "HC DEBRIDE SKIN SUB-Q TISS MUSCLE =<20 SQ CM", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 702.81, "discounted_cash": 729.0, "minimum": 210.843, "maximum": 702.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 702.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EPSTEIN-BARR ANTIBODY,EARLY", "code_information": [ { "code": "86663", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.56, "discounted_cash": 13.0, "minimum": 12.75, "maximum": 180.1203, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.75, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INCISION & DRAIN PILONIDAL CYST COMPLICATED", "code_information": [ { "code": "10081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6865.94, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 5987.0997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3343.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI JOINT UPPER EXTREM W/CONTRAST", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2768.44, "discounted_cash": 773.0, "minimum": 773.49, "maximum": 2768.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1413.89, "10th_percentile": 1413.89, "90th_percentile": 1413.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2768.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2768.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2768.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2158.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ondansetron HCl Oral Soln 4 MG/5ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "50268064711", "type": "NDC" }, { "code": "Q0162", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY WITH CCMCC", "code_information": [ { "code": "713", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12482.0, "minimum": 10008.24, "maximum": 43524.7813, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27166.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30115.6 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12482.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10008.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12482.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30115.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12482.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16720.33 } ] } ] }, { "description": "HC BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL", "code_information": [ { "code": "35571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6334.69, "minimum": 1900.407, "maximum": 6334.69, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6334.69 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "716", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12235.0, "minimum": 9823.44, "maximum": 31812.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11783.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26580.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11783.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11783.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31812.61 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12235.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9823.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12235.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31812.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11783.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12235.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11783.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16359.99 } ] } ] }, { "description": "HC ASSAY OF SOMATOSTATIN", "code_information": [ { "code": "84307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 744.06, "discounted_cash": 18.0, "minimum": 17.7645, "maximum": 648.8203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARTHROGRAM OF ELBOW", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 952.5, "discounted_cash": 344.0, "minimum": 285.75, "maximum": 952.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 952.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 952.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 952.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 655.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY JAW <4 VW", "code_information": [ { "code": "70100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 670.0, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 584.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 118.41, "10th_percentile": 118.41, "90th_percentile": 118.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33167.0, "minimum": 9459.22, "maximum": 76312.5483, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31867.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 76312.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31867.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31867.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9459.22 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33167.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28797.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33167.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9459.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31867.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 33167.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31867.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46969.08 } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17038.0, "minimum": 14753.51, "maximum": 37991.8386, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16391.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37991.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16391.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16391.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 35812.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17038.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14753.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17038.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35812.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16391.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17038.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16391.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23383.33 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "743", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10484.0, "minimum": 8296.6, "maximum": 28151.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22419.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28151.66 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8296.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28151.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10484.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10102.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13798.67 } ] } ] }, { "description": "Tacrolimus Cap 1 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904709761", "type": "NDC" }, { "code": "J7507", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS", "code_information": [ { "code": "93615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3523.13, "discounted_cash": 1201.0, "minimum": 1056.939, "maximum": 3523.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2031.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4132) GRAFIX CORE, GRAFIXPL CORE", "code_information": [ { "code": "Q4132", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 80.625, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5072) URINARY POUCH W/O BARRIER", "code_information": [ { "code": "A5072", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 4.8979, "maximum": 8.5236, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX LARGE VESSEL(S),LIMITED", "code_information": [ { "code": "93979", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1230.94, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1073.3797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 272.75, "10th_percentile": 272.75, "90th_percentile": 272.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, LOWER EXTREM", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2488.44, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2169.9197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1462.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 641.76, "10th_percentile": 641.76, "90th_percentile": 641.76, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ULTRASOUND,SCROTUM & CONTENTS", "code_information": [ { "code": "76870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1040.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 906.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 527.52, "10th_percentile": 527.52, "90th_percentile": 527.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 497.69, "10th_percentile": 497.69, "90th_percentile": 1329.41, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 610.26, "10th_percentile": 610.26, "90th_percentile": 634.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 230.47, "10th_percentile": 230.47, "90th_percentile": 527.52, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 637.81, "10th_percentile": 318.91, "90th_percentile": 725.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Meningococcal (A, C, Y, and W-135) Tetanus Conjugate Vaccine", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "49281059058", "type": "NDC" }, { "code": "90619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 376.852, "maximum": 376.852, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 376.85 } ] } ] }, { "description": "HC NM LIVER IMAGING WITH FLOW", "code_information": [ { "code": "78202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 645.63, "discounted_cash": 535.0, "minimum": 193.689, "maximum": 645.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 645.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 645.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 645.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 645.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 645.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [ { "code": "964", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12704.0, "minimum": 10382.69, "maximum": 27693.8368, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12232.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27693.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12232.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12232.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26567.66 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12704.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10382.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12704.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26567.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12232.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12704.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12232.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17045.09 } ] } ] }, { "description": "HC RHEUMATOID FACTOR, QUANT", "code_information": [ { "code": "86431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.94, "discounted_cash": 5.0, "minimum": 5.5101, "maximum": 144.6997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 84.17, "10th_percentile": 84.17, "90th_percentile": 100.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 25.34, "10th_percentile": 25.34, "90th_percentile": 25.34, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRESS/DEBRIDE BURN <5% TOTAL SM", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.63, "discounted_cash": 197.0, "minimum": 99.189, "maximum": 330.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4452) WATERPROOF TAPE - A4452 - RU270003", "code_information": [ { "code": "A4452", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LYMPHANGIOGRAPHY PELVIC/ABDOMIN, BILAT", "code_information": [ { "code": "75807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1977.19, "discounted_cash": 3115.0, "minimum": 593.157, "maximum": 1977.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1813.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1977.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC FPVT ST ATHRC UNI CPLX LES 1ST VSL", "code_information": [ { "code": "37277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL", "code_information": [ { "code": "35566", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4650.0, "minimum": 1395.0, "maximum": 4650.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 4650.0 } ] } ] }, { "description": "HC AIRWAY INHALATION TREATMENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.06, "discounted_cash": 216.0, "minimum": 31.218, "maximum": 104.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC", "code_information": [ { "code": "737", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16719.0, "minimum": 13831.59, "maximum": 70683.9974, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37234.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41893.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16719.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13831.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16719.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41893.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16719.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22917.33 } ] } ] }, { "description": "Micafungin Sodium For IV Soln 50 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "42023022901", "type": "NDC" }, { "code": "J2248", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL L0460) TLSO 2 SHL SYMPHYS-STERN CST", "code_information": [ { "code": "L0460", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1204.0, "minimum": 1170.1249, "maximum": 2036.3401, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1204.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1204.08, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1462.6, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1204.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1170.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1204.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1204.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1204.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1312.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1204.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1204.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1204.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1204.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1204.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2036.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INCISION & DRAIN PILONIDAL CYST SIMPL", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.31, "discounted_cash": 698.0, "minimum": 123.093, "maximum": 410.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 250.0, "10th_percentile": 250.0, "90th_percentile": 250.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPSNG INTRVAS VC FILTR W VASC ACS VSSL RS&I", "code_information": [ { "code": "37192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11306.6, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 11306.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11306.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11306.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11306.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TILT TABLE EVALUATION", "code_information": [ { "code": "93660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1427.81, "discounted_cash": 368.0, "minimum": 368.19, "maximum": 1427.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1427.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1427.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1409.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 401.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC GROUP THERAPEUTIC PROCEDURES - 97150 - 42000022", "code_information": [ { "code": "97150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 17.0, "minimum": 16.783, "maximum": 117.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.98, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CAROTENE", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.13, "discounted_cash": 9.0, "minimum": 8.96, "maximum": 111.7294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ DX/THER SBST INTRLMNR CRV/THRC W IMG", "code_information": [ { "code": "62321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3506.56, "discounted_cash": 696.0, "minimum": 696.49, "maximum": 3333.1922, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1849.59, "10th_percentile": 1849.59, "90th_percentile": 1849.59, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC", "code_information": [ { "code": "815", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8759.0, "minimum": 7032.76, "maximum": 25907.989, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8447.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18322.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8447.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8447.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16305.71 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 25848.57, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 36266.92, "10th_percentile": 36266.92, "90th_percentile": 36266.92, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8759.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7032.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8759.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16305.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8447.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8759.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8447.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11277.38 } ] } ] }, { "description": "HC STOOL CULTURE,SALMONELLA & SHIGELLA", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.06, "discounted_cash": 9.0, "minimum": 9.1738, "maximum": 221.5403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 153.4, "10th_percentile": 153.4, "90th_percentile": 153.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 122.14, "10th_percentile": 122.14, "90th_percentile": 122.14, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 131.46, "10th_percentile": 131.46, "90th_percentile": 136.73, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 42.2, "10th_percentile": 42.2, "90th_percentile": 153.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 49.53, "10th_percentile": 49.37, "90th_percentile": 168.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM BONE MARROW IMAGING LTD AREA", "code_information": [ { "code": "78102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 817.81, "discounted_cash": 394.0, "minimum": 245.343, "maximum": 817.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 817.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 817.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 817.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 817.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4148) NEOX NEOX RT OR CLARIX CORD", "code_information": [ { "code": "Q4148", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 276.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US,PREG UTER,FET & MAT,+ DETL FET,ADDL", "code_information": [ { "code": "76812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 780.0, "minimum": 234.0, "maximum": 780.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 780.0 } ] } ] }, { "description": "HC INJ NERV BLCK, ILIOINGUINAL, ILIOHYPOGASTR", "code_information": [ { "code": "64425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1945.0, "discounted_cash": 696.0, "minimum": 583.5, "maximum": 1945.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1945.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1945.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1945.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG", "code_information": [ { "code": "93616", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3523.13, "discounted_cash": 1201.0, "minimum": 1056.939, "maximum": 3523.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2031.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN LUMBAR SPINE W CONTRAST", "code_information": [ { "code": "72132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2607.19, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2273.4697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1020.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1731.62, "10th_percentile": 1731.62, "90th_percentile": 1731.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IV INFU, THERAP/PROPH/DIAGN, INIT, 1ST HR", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1019.06, "discounted_cash": 209.0, "minimum": 209.87, "maximum": 1004.3749, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 515.0, "10th_percentile": 413.06, "90th_percentile": 547.85, "count": "15" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 826.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1004.37, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 803.53, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 495.04, "10th_percentile": 491.18, "90th_percentile": 594.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 493.5, "10th_percentile": 493.5, "90th_percentile": 493.5, "count": "37" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 505.34, "10th_percentile": 432.6, "90th_percentile": 645.68, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 566.5, "10th_percentile": 493.5, "90th_percentile": 566.5, "count": "40" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 354.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CTA H&N C+ W/NONCONTRAST IMG", "code_information": [ { "code": "70471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1688.75, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1647.3337, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC REPLACE PICC W PORT OR PUMP", "code_information": [ { "code": "36585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4016.88, "discounted_cash": 3115.0, "minimum": 1205.064, "maximum": 4016.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4016.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4016.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4016.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4016.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE OSMOLALITY", "code_information": [ { "code": "83935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.88, "discounted_cash": 6.0, "minimum": 6.6277, "maximum": 167.3194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 30.49, "10th_percentile": 30.49, "90th_percentile": 30.49, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 105.24, "10th_percentile": 105.24, "90th_percentile": 105.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 133.85, "10th_percentile": 133.85, "90th_percentile": 135.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CONTRAST INJ PERQ RADIOLOGIC EVAL GI TUBE", "code_information": [ { "code": "49465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 808.44, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 808.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 808.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 808.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 808.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC AMINO ACIDS, SINGLE QUANTITATION", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.31, "discounted_cash": 22.0, "minimum": 22.332, "maximum": 209.5503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.91, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX LO EXTREM ART BILAT", "code_information": [ { "code": "93925", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1873.44, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1633.6397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16766.0, "minimum": 13691.08, "maximum": 52545.4157, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16130.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37344.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16130.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 46103.78, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 95611.35, "10th_percentile": 95611.35, "90th_percentile": 95611.35, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16130.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46807.08 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13691.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46807.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16130.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16766.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16130.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22985.18 } ] } ] }, { "description": "HC FETAL BLEED SCREEN, ROSETTE", "code_information": [ { "code": "85461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.44, "discounted_cash": 9.0, "minimum": 9.096, "maximum": 251.5197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHROMOSOME ANAL:15-20,2 KARYOTYPES", "code_information": [ { "code": "88262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 965.31, "discounted_cash": 125.0, "minimum": 121.9512, "maximum": 841.7503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.43, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 121.95, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 658.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7525) TRACHEOSTOMY MASK - A7525 - 27100034", "code_information": [ { "code": "A7525", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.8571, "maximum": 4.9721, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.57, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.86, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11329.0, "minimum": 9763.92, "maximum": 29234.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10913.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24426.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10913.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10913.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29234.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11329.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9763.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11329.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29234.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10913.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11329.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10913.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15034.29 } ] } ] }, { "description": "HC INJ NERV BLCK, GREATER OCCIPITAL", "code_information": [ { "code": "64405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 619.06, "discounted_cash": 302.0, "minimum": 185.718, "maximum": 619.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 619.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 619.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 619.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RPLC CV CATH CMPLT TUNLD WO SUBQ PORT/PUMP", "code_information": [ { "code": "36581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4016.88, "discounted_cash": 3115.0, "minimum": 1205.064, "maximum": 4016.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4016.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4016.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4016.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 2346.18, "10th_percentile": 2346.18, "90th_percentile": 2346.18, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4016.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVE FOREIGN BODY SIMPLE", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.31, "discounted_cash": 401.0, "minimum": 112.593, "maximum": 375.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 6622.56, "10th_percentile": 6622.56, "90th_percentile": 6622.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 375.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6407) PACKING STRIPS, NON-IMPREG - A6407 - RU272061", "code_information": [ { "code": "A6407", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.585, "maximum": 4.4986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CSF SHUNT EVALUATION", "code_information": [ { "code": "78645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 828.44, "discounted_cash": 535.0, "minimum": 248.532, "maximum": 828.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 828.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 828.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 828.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 828.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATH PLC/COR ANGIO RS/I BYPSS ANGIO,W L VENTRIC", "code_information": [ { "code": "93459", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 9873.53, "10th_percentile": 9873.53, "90th_percentile": 9873.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 10626.03, "10th_percentile": 10626.03, "90th_percentile": 10626.03, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "747", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7586.0, "minimum": 6611.25, "maximum": 23920.922, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7321.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15534.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7321.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7321.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15958.91 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7586.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6611.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7586.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15958.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7321.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7586.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7321.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9561.31 } ] } ] }, { "description": "HC (SUP SHELL A4415) OST SKN BARR W/O CONV >4 SQI", "code_information": [ { "code": "A4415", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.3089, "maximum": 14.4598, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.31, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC", "code_information": [ { "code": "698", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13630.0, "minimum": 11634.06, "maximum": 35980.1285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13121.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29894.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13121.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13121.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26544.27 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13630.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11634.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13630.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26544.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13121.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13630.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13121.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18399.71 } ] } ] }, { "description": "HC REMV TRANSVEN PACER ELECTRODE,2 LEAD", "code_information": [ { "code": "33235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7560.31, "discounted_cash": 3687.0, "minimum": 2268.093, "maximum": 7560.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4019.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6235.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1733) CATH, EP, OTHR THAN COOL-TIP", "code_information": [ { "code": "C1733", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 10164.34, "10th_percentile": 10164.34, "90th_percentile": 10164.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 12522.79, "10th_percentile": 12522.79, "90th_percentile": 12522.79, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4432) OS PCH URINE W BAR/FANGE/TAP", "code_information": [ { "code": "A4432", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 4.9659, "maximum": 8.642, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SIALOGRAM", "code_information": [ { "code": "70390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 988.75, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 988.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 988.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 859.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VALPROIC ACID, TOTAL", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.0, "discounted_cash": 13.0, "minimum": 13.1582, "maximum": 183.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 60.52, "10th_percentile": 60.52, "90th_percentile": 60.52, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC FPVT ST ATHRC UNI SF LES 1ST VSL", "code_information": [ { "code": "37275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAINAGE SCROTAL WALL ABSCESS", "code_information": [ { "code": "55100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1139.06, "discounted_cash": 1629.0, "minimum": 341.718, "maximum": 1139.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1139.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PRQ DRUG ELUTING COR REVASC CHRO SIN - 92943 - 48100199", "code_information": [ { "code": "92943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27935.9, "discounted_cash": 11390.0, "minimum": 8380.77, "maximum": 27935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT METATARSAL FX WO MANIP", "code_information": [ { "code": "28470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 487.5, "discounted_cash": 243.0, "minimum": 146.25, "maximum": 487.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 487.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 487.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 487.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTHER HORMON ANTINEOPL SUB-Q/IM", "code_information": [ { "code": "96402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 523.44, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 456.4397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 267.96, "10th_percentile": 267.96, "90th_percentile": 315.81, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 279.87, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.99, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 398.75, "10th_percentile": 398.75, "90th_percentile": 398.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 321.01, "10th_percentile": 305.68, "90th_percentile": 321.01, "count": "15" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 350.9, "10th_percentile": 350.9, "90th_percentile": 418.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE", "code_information": [ { "code": "49322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21365.3, "discounted_cash": 5965.0, "minimum": 5965.14, "maximum": 21365.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21365.3, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21365.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21365.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6502.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10088.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLATELET PHERESIS LEUKOREDUCED PROD", "code_information": [ { "code": "P9035", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3839.69, "discounted_cash": 509.0, "minimum": 509.08, "maximum": 3348.2097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2892.92, "10th_percentile": 798.38, "90th_percentile": 5837.44, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2005.57, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2436.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1949.11, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 2825.11, "10th_percentile": 2825.11, "90th_percentile": 4709.61, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 554.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 860.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ VERTEBRAL AUGMENTATION, THORACIC", "code_information": [ { "code": "22513", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39276.9, "discounted_cash": 7159.0, "minimum": 7159.72, "maximum": 34264.272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28206.43, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34264.27, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27412.42, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12108.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HHV-6, DNA AMP PROBE", "code_information": [ { "code": "87532", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 348.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8000) MASTECTOMY BRA", "code_information": [ { "code": "L8000", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 45.0, "minimum": 44.2363, "maximum": 76.9834, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.29, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC URINALYSIS", "code_information": [ { "code": "81005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.75, "discounted_cash": 2.0, "minimum": 2.1088, "maximum": 59.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.11, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT I-P JT,TOE DISLOC WO ANES", "code_information": [ { "code": "28660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 441.25, "discounted_cash": 243.0, "minimum": 132.375, "maximum": 441.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BILIARY ENDOSCOPY PERCUT,DIL STRICT", "code_information": [ { "code": "47555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2937.81, "discounted_cash": 6387.0, "minimum": 881.343, "maximum": 2937.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC", "code_information": [ { "code": "809", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10675.0, "minimum": 8572.07, "maximum": 24327.2845, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10286.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22874.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10286.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10286.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17014.91 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10675.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8572.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10675.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17014.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10286.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10675.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10286.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14078.93 } ] } ] }, { "description": "HC (SUP SHELL A4357) BEDSID DRN BAG DAY/NGT W/WO TUBE EA", "code_information": [ { "code": "A4357", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 11.0, "minimum": 11.4284, "maximum": 19.8885, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HELICOBACTER PYLORI", "code_information": [ { "code": "86677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.69, "discounted_cash": 16.0, "minimum": 16.3748, "maximum": 100.0097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.47, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.37, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TRIMALLEOLAR FX W MANIP", "code_information": [ { "code": "27818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 576.25, "discounted_cash": 1586.0, "minimum": 172.875, "maximum": 576.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 576.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25464.0, "minimum": 19809.54, "maximum": 69429.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58011.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 69429.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25464.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19809.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25464.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69429.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25464.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35705.04 } ] } ] }, { "description": "HC RIGHT VENTRICULAR RECORDING", "code_information": [ { "code": "93603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3929.69, "discounted_cash": 1201.0, "minimum": 1178.907, "maximum": 3929.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3929.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3929.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3929.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2031.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC", "code_information": [ { "code": "097", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28517.0, "minimum": 24810.2, "maximum": 65264.6481, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27406.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 61902.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28517.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24810.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28517.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 61902.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27406.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28517.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27406.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40169.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27406.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 65264.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27406.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Rabies Immune Globulin (Human) Inj 1500 Unt/5ML (300 Unt/ML)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "13533031801", "type": "NDC" }, { "code": "90375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 275.0, "minimum": 271.9582, "maximum": 1084.0991, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 7089.68, "10th_percentile": 7089.68, "90th_percentile": 7089.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1084.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.93, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.96, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 275.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 465.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Diazepam Inj 5 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409127303", "type": "NDC" }, { "code": "J3360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 12.4485, "maximum": 12.4485, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.45 } ] } ] }, { "description": "HC CHEM CAUTERY GRANULATN TISSUE", "code_information": [ { "code": "17250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 810.94, "discounted_cash": 197.0, "minimum": 197.97, "maximum": 810.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 779.92, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 810.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 757.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4128) FLEXHD/ALLOPATCHHD/MATRIXHD", "code_information": [ { "code": "Q4128", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 52.6105, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT", "code_information": [ { "code": "34706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6369.69, "minimum": 1910.907, "maximum": 6369.69, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6369.69 } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC", "code_information": [ { "code": "062", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14412.0, "minimum": 12326.2, "maximum": 63868.1364, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13871.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31752.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13871.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13871.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37303.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14412.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12326.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14412.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37303.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13871.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14412.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13871.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19543.02 } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CCMCC", "code_information": [ { "code": "063", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11724.0, "minimum": 9723.08, "maximum": 57234.3653, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11292.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25366.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11292.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11292.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31798.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11724.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9723.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11724.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31799.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11292.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11724.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11292.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15612.61 } ] } ] }, { "description": "HC RUSSELL VIPER VENOM, DILUTED", "code_information": [ { "code": "85613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.5, "discounted_cash": 9.0, "minimum": 9.3098, "maximum": 102.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 59.64, "10th_percentile": 59.64, "90th_percentile": 59.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.31, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 60.85, "10th_percentile": 60.85, "90th_percentile": 63.23, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 78.1, "10th_percentile": 9.58, "90th_percentile": 81.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT HEEL FX WO MANIP", "code_information": [ { "code": "28400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL E0978) W/C ACC,SAF BELT PELV STRAP", "code_information": [ { "code": "E0978", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 29.0, "minimum": 28.843, "maximum": 50.1948, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.05, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.84, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4509.0, "minimum": 3057.15, "maximum": 9843.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4369.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 8223.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 4369.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 4369.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9843.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 4509.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3057.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4509.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9843.04 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4369.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 4509.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 4369.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5061.48 } ] } ] }, { "description": "HC ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION", "code_information": [ { "code": "76982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 590.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 573.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY L/S RATIO", "code_information": [ { "code": "83661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.88, "discounted_cash": 21.0, "minimum": 21.3699, "maximum": 276.3194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.71, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.37, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RANGE OF MOTION MEASUREMENTS - 95851 - 42000051", "code_information": [ { "code": "95851", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.94, "discounted_cash": 6.0, "minimum": 6.2875, "maximum": 80.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9699.0, "minimum": 7092.98, "maximum": 23569.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9349.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20554.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9349.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9349.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23569.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9699.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7092.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9699.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23569.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9349.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9699.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9349.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12650.91 } ] } ] }, { "description": "HC X-RAY NECK SOFT TISSUE", "code_information": [ { "code": "70360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 428.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 44.7, "10th_percentile": 44.7, "90th_percentile": 44.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 125.65, "10th_percentile": 125.65, "90th_percentile": 125.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 198.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 89.4, "10th_percentile": 89.4, "90th_percentile": 89.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 291.68, "10th_percentile": 241.86, "90th_percentile": 291.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY ABDOMEN,COMP ACUTE SERIES", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 963.75, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 840.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 565.36, "10th_percentile": 565.36, "90th_percentile": 565.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 307.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 639.98, "10th_percentile": 639.98, "90th_percentile": 672.31, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4450) NON-WATERPROOF TAPE - A4450 - RU270002", "code_information": [ { "code": "A4450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTX ADMN CNS REQ SPINAL PUNCTURE", "code_information": [ { "code": "96450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1420.0, "discounted_cash": 325.0, "minimum": 325.91, "maximum": 1420.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1283.96, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1420.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1247.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 551.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylprednisolone Acetate Inj Susp 80 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "70121157401", "type": "NDC" }, { "code": "J1010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL L8606) SYNTHETIC IMPLNT URINARY 1ML", "code_information": [ { "code": "L8606", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 263.0, "minimum": 256.0401, "maximum": 445.5805, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2591.62, "10th_percentile": 2591.62, "90th_percentile": 2774.19, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 263.47, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 320.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 256.04, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 2508.51, "10th_percentile": 2508.51, "90th_percentile": 2508.51, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 263.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 263.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 287.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2709.16, "10th_percentile": 2709.16, "90th_percentile": 2709.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 263.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 445.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PARAFFIN BATH THERAPY", "code_information": [ { "code": "97018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.06, "discounted_cash": 5.0, "minimum": 5.4324, "maximum": 89.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD CLOT FACTOR IX TEST", "code_information": [ { "code": "85250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 723.13, "discounted_cash": 19.0, "minimum": 18.5031, "maximum": 630.5694, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.13, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 504.45, "10th_percentile": 504.45, "90th_percentile": 504.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC DEHYDROEPIANDROSTERONE-SULFATE", "code_information": [ { "code": "82627", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.94, "discounted_cash": 22.0, "minimum": 21.6031, "maximum": 327.8197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 240.6, "10th_percentile": 240.6, "90th_percentile": 240.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.6, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 206.19, "10th_percentile": 206.19, "90th_percentile": 206.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 99.37, "10th_percentile": 99.37, "90th_percentile": 99.37, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 262.25, "10th_percentile": 262.25, "90th_percentile": 264.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Octreotide Acetate Inj 100 MCG/ML (0.1 MG/ML)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323037600", "type": "NDC" }, { "code": "J2354", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.2685, "maximum": 1.2685, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.27 } ] } ] }, { "description": "HC COMPLEX DRAINAGE, WOUND", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8610.31, "discounted_cash": 2866.0, "minimum": 2583.093, "maximum": 8610.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8610.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8610.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8610.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4847.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "700", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6294.0, "minimum": 4804.79, "maximum": 13381.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6082.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12466.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6082.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6082.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13381.24 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6294.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4804.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6294.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13381.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6082.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6294.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6082.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7672.85 } ] } ] }, { "description": "HC REPR WND INTRMD BODY/SCALP/EXTR <2.5 CM", "code_information": [ { "code": "12031", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRICHOMONAS VAGINALIS AMPLIF", "code_information": [ { "code": "87661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.13, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 321.0094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3923) HFO WITHOUT JOINTS PRE CST", "code_information": [ { "code": "L3923", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 130.0, "minimum": 126.7422, "maximum": 220.5663, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 61.82, "10th_percentile": 61.82, "90th_percentile": 61.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.42, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 126.74, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 75.13, "10th_percentile": 71.52, "90th_percentile": 75.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 70.53, "10th_percentile": 70.53, "90th_percentile": 70.53, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 72.86, "10th_percentile": 72.86, "90th_percentile": 72.86, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 80.96, "10th_percentile": 80.96, "90th_percentile": 85.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 220.57, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH MCC", "code_information": [ { "code": "466", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40637.0, "minimum": 35261.41, "maximum": 94060.7451, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39035.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 94060.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 39035.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 39035.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 92940.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 40637.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35261.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40637.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 92940.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39035.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 40637.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39035.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57892.79 } ] } ] }, { "description": "HC VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I", "code_information": [ { "code": "37241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34679.1, "discounted_cash": 11390.0, "minimum": 10403.73, "maximum": 34679.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34679.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34679.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34679.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9", "code_information": [ { "code": "86301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.75, "discounted_cash": 20.0, "minimum": 20.2232, "maximum": 120.99, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 83.8, "10th_percentile": 83.8, "90th_percentile": 83.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 74.67, "10th_percentile": 71.82, "90th_percentile": 74.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 20.81, "10th_percentile": 20.81, "90th_percentile": 20.81, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTIHUMAN GLOBULIN INDIRECT EA ANTIBODY TITER", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 299.38, "discounted_cash": 168.0, "minimum": 27.1805, "maximum": 299.38, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.29, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 299.38, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 299.38, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 299.38, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MR ANGIO, NECK W/CONTRAST", "code_information": [ { "code": "70548", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2180.63, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1901.5094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1605.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROSTHETIC TRAIN INITIAL ENCTR EA 15 MIN", "code_information": [ { "code": "97761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 38.0, "minimum": 37.3366, "maximum": 128.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EPHYS EVL TRNSPTL TX ATRIL FIB ISOLAT PULM VEIN", "code_information": [ { "code": "93656", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60116.9, "discounted_cash": 25790.0, "minimum": 18035.07, "maximum": 60116.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 31563.5, "10th_percentile": 31563.5, "90th_percentile": 31563.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60116.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60116.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60116.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 36453.65, "10th_percentile": 36453.65, "90th_percentile": 37760.32, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28111.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 37825.77, "10th_percentile": 37825.77, "90th_percentile": 37825.77, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43616.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN OF ABDOMEN CONTRAST", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3446.56, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 3005.4003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1576.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1784.26, "10th_percentile": 1784.26, "90th_percentile": 1784.26, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cyclosporine Modified Cap 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00093902019", "type": "NDC" }, { "code": "J7502", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.343, "maximum": 4.343, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.34 } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45680.0, "minimum": 40726.49, "maximum": 122563.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 106044.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 43875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 88234.35, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 84612.37, "10th_percentile": 84612.37, "90th_percentile": 84612.37, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 43875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 122562.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 45680.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40726.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45680.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 122563.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 45680.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 43875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65268.69 } ] } ] }, { "description": "HC GARDNER VAG DNA DIR PROBE", "code_information": [ { "code": "87510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.88, "discounted_cash": 20.0, "minimum": 19.4846, "maximum": 81.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 49.4, "10th_percentile": 41.5, "90th_percentile": 49.4, "count": "34" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.48, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 41.72, "10th_percentile": 41.72, "90th_percentile": 41.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 42.34, "10th_percentile": 42.34, "90th_percentile": 44.06, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 65.5, "10th_percentile": 49.4, "90th_percentile": 65.5, "count": "18" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 57.12, "10th_percentile": 57.12, "90th_percentile": 57.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7858.0, "minimum": 6186.28, "maximum": 16181.5417, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7583.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16181.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7583.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7583.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13599.46 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7858.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6186.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7858.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13599.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7583.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7858.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7583.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9959.46 } ] } ] }, { "description": "HC (SUP SHELL A6445) CONFORM BAND S W <3/YD", "code_information": [ { "code": "A6445", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC STRAPPING UNNA BOOT", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 884.69, "discounted_cash": 160.0, "minimum": 160.33, "maximum": 771.4497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 631.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 767.29, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 613.86, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CONTROL NOSE BLEED POST PACK/CAUT INIT", "code_information": [ { "code": "30905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 489.38, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 489.38, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 489.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 489.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 489.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose 5% w/ Sodium Chloride 0.45%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338008504", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.913, "maximum": 3.913, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.91 } ] } ] }, { "description": "HC (SUP SHELL C1751) CATH INFUS INSRT PERIPH CNTRL/MIDLN", "code_information": [ { "code": "C1751", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 227.64, "10th_percentile": 227.64, "90th_percentile": 227.64, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 259.69, "10th_percentile": 259.69, "90th_percentile": 259.69, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 268.29, "10th_percentile": 227.64, "90th_percentile": 284.56, "count": "1 through 10" } ] } ] }, { "description": "HC NK CELLS TOTAL COUNT", "code_information": [ { "code": "86357", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.63, "discounted_cash": 37.0, "minimum": 36.666, "maximum": 270.8694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 166.55, "10th_percentile": 166.55, "90th_percentile": 166.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Colistimethate Sod For Inj 150 MG (Colistin Base Activity)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323039306", "type": "NDC" }, { "code": "J0770", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.671, "maximum": 25.671, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.67 } ] } ] }, { "description": "HC X-RAY ARM, INFANT", "code_information": [ { "code": "73092", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TOE FX WO MANIP EA", "code_information": [ { "code": "28510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 407.5, "discounted_cash": 243.0, "minimum": 122.25, "maximum": 407.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 407.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 407.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 407.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 407.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ, THERAP/PROPH/DIAGN, INTRA-ARTERIAL", "code_information": [ { "code": "96373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 367.19, "discounted_cash": 209.0, "minimum": 110.157, "maximum": 367.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 367.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 367.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 354.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TB TEST, CELL MDIATD ANTGEN RESPS GAMMA INTFRON", "code_information": [ { "code": "86480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 399.06, "discounted_cash": 61.0, "minimum": 60.2322, "maximum": 347.9803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 241.0, "10th_percentile": 241.0, "90th_percentile": 241.0, "count": "14" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.29, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 203.36, "10th_percentile": 191.9, "90th_percentile": 203.36, "count": "12" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 214.76, "10th_percentile": 206.54, "90th_percentile": 214.76, "count": "21" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 277.05, "10th_percentile": 241.0, "90th_percentile": 277.05, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 278.39, "10th_percentile": 265.1, "90th_percentile": 301.25, "count": "35" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 104.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT TUNNLD CV CATH W 2 ACSS SITES WO PUMP/PORT", "code_information": [ { "code": "36565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7702.81, "discounted_cash": 3115.0, "minimum": 2310.843, "maximum": 7702.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7702.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7702.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7702.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN K", "code_information": [ { "code": "84597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.31, "discounted_cash": 13.0, "minimum": 13.3331, "maximum": 209.5503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 153.8, "10th_percentile": 153.8, "90th_percentile": 153.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 122.46, "10th_percentile": 122.46, "90th_percentile": 122.46, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 131.81, "10th_percentile": 129.33, "90th_percentile": 131.81, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 61.33, "10th_percentile": 61.33, "90th_percentile": 153.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 169.18, "10th_percentile": 167.64, "90th_percentile": 169.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPOSITION TRANSVENOUS PM/ELECTRODE", "code_information": [ { "code": "33215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7560.31, "discounted_cash": 3115.0, "minimum": 2268.093, "maximum": 7560.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LYMPHATICS & LYMPH GLANDS IMAGING", "code_information": [ { "code": "78195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1480.63, "discounted_cash": 535.0, "minimum": 444.189, "maximum": 1480.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1480.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1480.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1480.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1480.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Metoclopramide HCl Inj 5 MG/ML (Base Equivalent)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409341421", "type": "NDC" }, { "code": "J2765", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.4295, "maximum": 2.4295, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.43 } ] } ] }, { "description": "Gentamicin Sulfate Inj 40 MG/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323001003", "type": "NDC" }, { "code": "J1580", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.3105, "maximum": 5.3105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 38.53, "10th_percentile": 38.53, "90th_percentile": 38.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.31 } ] } ] }, { "description": "HC DUPLEX ABD/PEL VASC STUDY,COMPLETE", "code_information": [ { "code": "93975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2032.81, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1772.6103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 815.81, "10th_percentile": 815.81, "90th_percentile": 815.81, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 961.49, "10th_percentile": 356.43, "90th_percentile": 1010.1, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9288.0, "minimum": 7538.02, "maximum": 23147.1516, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8955.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19578.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8955.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8955.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19832.22 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9288.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7538.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9288.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19832.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8955.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9288.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8955.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12050.34 } ] } ] }, { "description": "HC US NRV&ACC STRUX 1XTR COMPRE", "code_information": [ { "code": "76883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5872.19, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 5120.5497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC", "code_information": [ { "code": "012", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33112.0, "minimum": 28403.06, "maximum": 83484.71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31815.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 76182.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31815.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31815.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 83484.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33112.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28403.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33112.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 83484.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31815.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 33112.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31815.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46889.0 } ] } ] }, { "description": "HC TRANSLUM PERIPHERAL ATHERECTOMY ILIAC ARTERY EA", "code_information": [ { "code": "0238T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49946.3, "discounted_cash": 18087.0, "minimum": 14983.89, "maximum": 49946.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49946.3, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49946.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49946.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ORBITAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "113", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18929.0, "minimum": 15484.4, "maximum": 58109.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18205.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 42484.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18205.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18205.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 58109.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18929.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15484.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18929.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58109.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18205.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18929.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18205.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26148.18 } ] } ] }, { "description": "HC SENSORY INTEGRATION EA 15 MIN", "code_information": [ { "code": "97533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.69, "discounted_cash": 57.0, "minimum": 31.407, "maximum": 96.5844, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.37, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4414) OST SKNBAR W/O CONV<=4 SQ IN", "code_information": [ { "code": "A4414", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 6.8123, "maximum": 11.8553, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A2001) INNOVAMATRIX AC, PER SQ CM", "code_information": [ { "code": "A2001", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEOXYCORTISOL", "code_information": [ { "code": "82634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 395.94, "discounted_cash": 29.0, "minimum": 28.4543, "maximum": 345.2597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.57, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.92, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL - 77049 - 61077049", "code_information": [ { "code": "77049", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1173.75, "minimum": 352.125, "maximum": 1173.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 431.0, "10th_percentile": 200.01, "90th_percentile": 631.01, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1173.75 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 414.77, "10th_percentile": 414.77, "90th_percentile": 414.77, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 826.32, "10th_percentile": 826.32, "90th_percentile": 826.32, "count": "1 through 10" } ] } ] }, { "description": "HC VENT MANAGEMENT, INPAT/OBSER, EA SUBQ DAY", "code_information": [ { "code": "94003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1044.38, "discounted_cash": 609.0, "minimum": 313.314, "maximum": 1044.38, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 664.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1030.9, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1044.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1044.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1044.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 609.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC NM INJECT RADIOPHARM NON-IMAGING LOCALIZATION, IV", "code_information": [ { "code": "78808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.69, "discounted_cash": 394.0, "minimum": 299.907, "maximum": 999.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 999.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 999.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 999.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINA, CERVIX AND VULVA PROCEDURES WITH CCMCC", "code_information": [ { "code": "746", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14259.0, "minimum": 11590.46, "maximum": 42667.8058, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31389.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38140.83 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14259.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11590.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14259.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38140.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14259.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19319.47 } ] } ] }, { "description": "HC THYROGLOBULIN ANTIBODY", "code_information": [ { "code": "86800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.44, "discounted_cash": 15.0, "minimum": 15.4613, "maximum": 207.9197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 144.0, "10th_percentile": 120.96, "90th_percentile": 144.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.33, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 121.51, "10th_percentile": 121.51, "90th_percentile": 121.51, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 123.41, "10th_percentile": 123.41, "90th_percentile": 128.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 158.4, "10th_percentile": 83.48, "90th_percentile": 166.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC GROUP MNT 2 OR MORE 30 MINS", "code_information": [ { "code": "G0271", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.31, "discounted_cash": 11.0, "minimum": 9.093, "maximum": 26.4303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEPATITIS BE AB TEST", "code_information": [ { "code": "86707", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.06, "discounted_cash": 11.0, "minimum": 11.2437, "maximum": 125.6203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 73.08, "10th_percentile": 73.08, "90th_percentile": 73.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.24, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 74.56, "10th_percentile": 74.56, "90th_percentile": 74.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 60.71, "10th_percentile": 60.71, "90th_percentile": 100.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM LIVER IMAGING", "code_information": [ { "code": "78201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1705.0, "discounted_cash": 535.0, "minimum": 511.5, "maximum": 1705.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1705.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1705.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1705.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1377.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY THORACIC SPINE 4 VW", "code_information": [ { "code": "72074", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 800.94, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 698.4197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT", "code_information": [ { "code": "469", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24116.0, "minimum": 22623.75, "maximum": 66779.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 54809.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 66779.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24116.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22623.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24116.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66779.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24116.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33734.28 } ] } ] }, { "description": "HC PRQ TCAT CLSR CGEN VENTR SEPTAL DFCT W/IMPLT", "code_information": [ { "code": "93581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67787.8, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 67787.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67787.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67787.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 67787.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 40 MG/0.4ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323056421", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.118, "maximum": 1.118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.12 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "HC DESTRUCTION BENIGN LESIONS UP TO 14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 746.56, "discounted_cash": 197.0, "minimum": 197.97, "maximum": 746.56, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 746.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 746.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 746.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "499", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16371.0, "minimum": 7604.47, "maximum": 40917.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15751.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36407.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15751.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15751.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40917.23 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16371.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7604.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16371.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40917.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15751.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16371.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15751.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22407.96 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9371.0, "minimum": 7506.18, "maximum": 33383.0413, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9034.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19775.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9034.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9034.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19380.2 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9371.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7506.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9371.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19380.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9034.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9371.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9034.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12171.57 } ] } ] }, { "description": "HC US GUID,COMP REPAIR,PSEUDO-ANEUR/AV FIST", "code_information": [ { "code": "76936", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 694.38, "discounted_cash": 213.0, "minimum": 208.314, "maximum": 694.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 694.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 694.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 694.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 694.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY STERNUM 2+ VW", "code_information": [ { "code": "71120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 615.94, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 537.0997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLCMT URETERAL STENT, NEW ACCESS W SEP NEPH CATH", "code_information": [ { "code": "50695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11736.6, "discounted_cash": 3478.0, "minimum": 3478.1, "maximum": 11736.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11736.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11736.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11736.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3791.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5882.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IV INFU, THERAP/PROPH/DIAGN,CONCURRENT INF", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.81, "minimum": 120.843, "maximum": 351.2503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 216.55, "10th_percentile": 216.55, "90th_percentile": 216.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 196.44, "10th_percentile": 196.44, "90th_percentile": 196.44, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 201.16, "10th_percentile": 201.16, "90th_percentile": 201.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 196.44, "10th_percentile": 196.44, "90th_percentile": 225.5, "count": "1 through 10" } ] } ] }, { "description": "URINARY STONES WITHOUT MCC", "code_information": [ { "code": "694", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6993.0, "minimum": 5408.33, "maximum": 28330.2053, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6752.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14125.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6752.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 24779.18, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7994.58, "10th_percentile": 7994.58, "90th_percentile": 7994.58, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6752.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11491.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6993.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5408.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6993.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11491.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6752.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6993.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6752.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8693.82 } ] } ] }, { "description": "HC SWALLOWING FCN,W/CINE &/OR VIDEO", "code_information": [ { "code": "74230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1111.25, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 969.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 671.0, "10th_percentile": 671.0, "90th_percentile": 671.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 652.04, "10th_percentile": 652.04, "90th_percentile": 678.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 681.51, "10th_percentile": 681.51, "90th_percentile": 681.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6222) GAUZE <=16 IN NO W/SAL W/O B - A6222 - 27200126", "code_information": [ { "code": "A6222", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 2.9543, "maximum": 5.1412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.95, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRUG SCRN QUANT OXCARBAZEPIN", "code_information": [ { "code": "80183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.5, "discounted_cash": 13.0, "minimum": 12.8764, "maximum": 102.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 59.23, "10th_percentile": 59.23, "90th_percentile": 59.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 78.1, "10th_percentile": 78.1, "90th_percentile": 78.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC", "code_information": [ { "code": "394", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8164.0, "minimum": 6515.05, "maximum": 23550.8771, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7876.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8164.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7876.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10406.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7876.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16907.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7876.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 20598.92, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22850.18, "10th_percentile": 22850.18, "90th_percentile": 22850.18, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7876.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16126.46 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 23496.86, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12869.36, "10th_percentile": 12869.36, "90th_percentile": 12869.36, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8164.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6515.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8164.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16126.5 } ] } ] }, { "description": "HC X-RAY SHOULDER 2+ VW", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 537.5, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 468.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 324.6, "10th_percentile": 272.66, "90th_percentile": 545.33, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 272.62, "10th_percentile": 272.62, "90th_percentile": 272.62, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 327.96, "10th_percentile": 315.43, "90th_percentile": 327.96, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 101.25, "10th_percentile": 101.25, "90th_percentile": 101.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 374.96, "10th_percentile": 374.96, "90th_percentile": 374.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EXPLORE WOUND ABDOMEN/FLANK/BACK", "code_information": [ { "code": "20102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8511.25, "discounted_cash": 2035.0, "minimum": 2035.84, "maximum": 8511.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8020.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8511.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7794.62, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hydromorphone HCl Inj 1 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409128303", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.98, "10th_percentile": 11.99, "90th_percentile": 39.11, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 44.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "Nitroglycerin IV Soln 400 MCG/ML in D5W", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "00338105102", "type": "NDC" }, { "code": "J2305", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.881, "maximum": 2.881, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.88 } ] } ] }, { "description": "HC REPLACE PICC WO PORT/PUMP", "code_information": [ { "code": "36584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6268.75, "discounted_cash": 1553.0, "minimum": 1553.22, "maximum": 6268.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6119.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6268.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5946.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US,PREG UTER,FET & MAT,+ DETL FET EXM", "code_information": [ { "code": "76811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1164.38, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1126.6495, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 775.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT PICC W/ SUB-Q PORT", "code_information": [ { "code": "36571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4712.19, "discounted_cash": 3115.0, "minimum": 1413.657, "maximum": 4712.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4712.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4712.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4712.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4712.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CONVERSION BILIARY DRG CATH, EXT TO INT-EXT", "code_information": [ { "code": "47535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15636.9, "discounted_cash": 3532.0, "minimum": 3532.78, "maximum": 15636.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13917.74, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15636.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13525.95, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Epoetin Alfa-epbx Inj 10000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00069130801", "type": "NDC" }, { "code": "Q5106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.6286, "maximum": 31.0559, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SMEAR,PRIMARY W/INTERP", "code_information": [ { "code": "87205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.88, "discounted_cash": 4.0, "minimum": 4.1496, "maximum": 75.7594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.6, "10th_percentile": 43.34, "90th_percentile": 51.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 41.09, "10th_percentile": 41.09, "90th_percentile": 41.09, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 44.22, "10th_percentile": 44.22, "90th_percentile": 45.91, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 19.09, "10th_percentile": 19.09, "90th_percentile": 51.6, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.76, "10th_percentile": 56.76, "90th_percentile": 56.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4154) BIOVANCE 1 SQUARE CM", "code_information": [ { "code": "Q4154", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 287.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLASMA CRYOPRECIPITATE REDUCED, PER UNIT", "code_information": [ { "code": "P9044", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.25, "discounted_cash": 131.0, "minimum": 100.875, "maximum": 336.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 336.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 336.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 336.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PRQ TRLUML CORONRY ANGIO/ATHERECT ONE ART/BRNCH", "code_information": [ { "code": "92924", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35072.8, "discounted_cash": 11390.0, "minimum": 10521.84, "maximum": 35072.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35072.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35072.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35072.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INCISION OF EYELID FOLD", "code_information": [ { "code": "67715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8751.25, "discounted_cash": 2345.0, "minimum": 2345.87, "maximum": 8751.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8751.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8751.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8751.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2557.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3967.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EVAL,SWALLOW FUNCTION,CINE/VIDEO RECORD, 30 MIN", "code_information": [ { "code": "92611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 531.56, "discounted_cash": 87.0, "minimum": 84.741, "maximum": 463.5203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 340.2, "10th_percentile": 340.2, "90th_percentile": 340.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.2, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.92, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.74, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 87.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 87.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 87.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 87.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4118) MATRISTEM MICROMATRIX", "code_information": [ { "code": "Q4118", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.4825, "maximum": 5.4825, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 } ] } ] }, { "description": "HC RADEX SPINE CERVICAL 6 OR MORE VIEWS", "code_information": [ { "code": "72052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 855.94, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 746.3797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 188.41, "10th_percentile": 188.41, "90th_percentile": 188.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 409.56, "10th_percentile": 409.56, "90th_percentile": 409.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 424.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 597.1, "10th_percentile": 597.1, "90th_percentile": 597.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED FLUOROSCOPIC PROCEDURE", "code_information": [ { "code": "76496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 467.81, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6212) FOAM DRG <=16 SQ IN W/BORDER - A6212 - 27100084", "code_information": [ { "code": "A6212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 13.0, "minimum": 13.4497, "maximum": 23.4062, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9947.0, "minimum": 7190.2842, "maximum": 25307.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9587.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21145.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9587.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9587.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25307.07 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9947.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8738.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25307.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9587.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9947.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9587.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13014.59 } ] } ] }, { "description": "HC ABLATE AV NODE FUNCTION", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22680.9, "discounted_cash": 7695.0, "minimum": 6804.27, "maximum": 22680.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22680.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22680.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22680.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8388.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7695.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13015.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ CERVICOTHORACIC INJ", "code_information": [ { "code": "22510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16164.4, "discounted_cash": 3228.0, "minimum": 3228.48, "maximum": 15450.5367, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12718.92, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15450.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12360.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES", "code_information": [ { "code": "483", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22129.0, "minimum": 17636.93, "maximum": 86163.326, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21276.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22129.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21276.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30828.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21276.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 50087.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21276.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21276.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 52993.08 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22129.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17636.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22129.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52993.1 } ] } ] }, { "description": "HC ANGIO PULMON BILAT SELECT", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9589.06, "discounted_cash": 3115.0, "minimum": 631.8398, "maximum": 9589.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9589.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9589.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9589.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 631.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN LUMBAR SPINE WO CONTRAST", "code_information": [ { "code": "72131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2379.69, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 2075.0897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1206.91, "10th_percentile": 1206.91, "90th_percentile": 1206.91, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1451.99, "10th_percentile": 1451.99, "90th_percentile": 1451.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 751.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN - 99214 - 76100009", "code_information": [ { "code": "99214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.56, "minimum": 87.468, "maximum": 254.2403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 186.6, "10th_percentile": 72.07, "90th_percentile": 186.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 81.8, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 84.19, "10th_percentile": 84.19, "90th_percentile": 184.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 93.52, "10th_percentile": 93.52, "90th_percentile": 94.38, "count": "14" } ] } ] }, { "description": "HC EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR - C9600 - 48193644", "code_information": [ { "code": "C9600", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1470.63, "discounted_cash": 11390.0, "minimum": 52.875, "maximum": 27387.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 15499.44, "10th_percentile": 15499.44, "90th_percentile": 15499.44, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1470.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CCMCC", "code_information": [ { "code": "760", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8710.0, "minimum": 6821.66, "maximum": 27992.7812, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8400.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18205.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8400.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8400.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12424.6 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8710.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6821.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8710.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12424.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8400.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8710.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8400.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11205.09 } ] } ] }, { "description": "HC ARC COLD AGGLUTININ SCREEN", "code_information": [ { "code": "86156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.38, "discounted_cash": 8.0, "minimum": 7.8424, "maximum": 169.4994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "255", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21562.0, "minimum": 18109.66, "maximum": 71303.7975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20732.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 48741.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20732.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20732.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 58335.45 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21562.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18109.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21562.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58335.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20732.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21562.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20732.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29999.62 } ] } ] }, { "description": "HC FERN TEST - Q0114 - 30600080", "code_information": [ { "code": "Q0114", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.13, "discounted_cash": 9.0, "minimum": 9.4653, "maximum": 76.8494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.83, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITH MCC", "code_information": [ { "code": "163", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35133.0, "minimum": 31901.79, "maximum": 118219.4275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33755.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 80985.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 33755.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33755.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 84371.21 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31901.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 84371.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33755.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 35133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33755.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49845.15 } ] } ] }, { "description": "HC CT GUIDE FOR TISSUE ABLATION", "code_information": [ { "code": "77013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 476.25, "minimum": 142.875, "maximum": 476.25, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.25 } ] } ] }, { "description": "HC DRAINAGE ABSCESS PALATE/UVULA", "code_information": [ { "code": "42000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1864.38, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 1625.7394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1118.42, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 894.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NO PT PRSNT TRAIN ADD 15", "code_information": [ { "code": "G0542", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.06, "discounted_cash": 23.0, "minimum": 23.29, "maximum": 147.4203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.75, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.46, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 89.17, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ THRMBC/NFS DIAL CIRC TCAT PLMT IV STENT S&I", "code_information": [ { "code": "36906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67841.3, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 67841.3, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 67841.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67841.3, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67841.3, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF SERUM SODIUM", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.19, "discounted_cash": 4.0, "minimum": 4.6744, "maximum": 41.1497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.37, "10th_percentile": 25.37, "90th_percentile": 30.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 24.05, "10th_percentile": 24.05, "90th_percentile": 24.05, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 25.88, "10th_percentile": 25.88, "90th_percentile": 25.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 32.92, "10th_percentile": 32.92, "90th_percentile": 32.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6255) ABSORPT DRG >16<=48 IN W/BDR - A6255 - RU272057", "code_information": [ { "code": "A6255", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.2176, "maximum": 7.3398, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.22, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEUROMUSC REEDUCAT,1+ AREAS COMPLEX, EA 15 MIN", "code_information": [ { "code": "97112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 31.0, "minimum": 30.4659, "maximum": 128.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.08, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.47, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL ARM/ELBOW FB SUBQ", "code_information": [ { "code": "24200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 743.75, "discounted_cash": 1629.0, "minimum": 223.125, "maximum": 743.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 743.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "508", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12565.0, "minimum": 8592.83, "maximum": 32751.71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12099.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27364.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12099.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12099.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32751.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12565.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8592.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12565.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32751.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12099.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12565.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12099.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16842.67 } ] } ] }, { "description": "HC OT EXERCISE OTA COMPLEX EA 15 - 97110 - 42000162", "code_information": [ { "code": "97110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 27.0, "minimum": 27.0549, "maximum": 128.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 79.3, "10th_percentile": 79.3, "90th_percentile": 79.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.82, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.05, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 102.9, "10th_percentile": 102.9, "90th_percentile": 103.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IV INFU, THERAP/PROPH/DIAGN, ADD INF, 1ST HR", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.31, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 320.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 344.4, "10th_percentile": 344.4, "90th_percentile": 344.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 279.87, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 320.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.99, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 195.52, "10th_percentile": 195.52, "90th_percentile": 195.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 196.44, "10th_percentile": 196.44, "90th_percentile": 392.88, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 82.66, "10th_percentile": 66.16, "90th_percentile": 402.31, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 225.5, "10th_percentile": 196.44, "90th_percentile": 451.0, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Tobramycin Sulfate Inj 1.2 GM/30ML (40 MG/ML) (Base Equiv)", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "67457042800", "type": "NDC" }, { "code": "J3260", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.44, "maximum": 3.44, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.44 } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "417", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19197.0, "minimum": 16448.54, "maximum": 49332.8964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18463.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 43121.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18463.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 43285.09, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 32615.23, "10th_percentile": 32615.23, "90th_percentile": 32615.23, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18463.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40969.84 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16448.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40969.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18463.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19197.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18463.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26540.78 } ] } ] }, { "description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [ { "code": "866", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7661.0, "minimum": 6123.99, "maximum": 16081.07, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7394.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15713.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7394.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7394.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13051.97 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7661.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6123.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7661.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13052.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7394.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7661.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7394.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9671.41 } ] } ] }, { "description": "HC (SUP SHELL Q4173) PALINGEN OR PALINGEN XPLUS", "code_information": [ { "code": "Q4173", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 775.0965, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 775.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0170) CERVICAL COLLAR MOLDED TO PT", "code_information": [ { "code": "L0170", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 945.0, "minimum": 918.3704, "maximum": 1598.2178, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 945.02, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1147.92, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 918.37, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 945.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 945.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1030.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 945.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 945.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1598.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM BRAIN FLOW IMAGING ONLY", "code_information": [ { "code": "78610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.19, "discounted_cash": 535.0, "minimum": 525.657, "maximum": 1752.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1752.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1752.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1752.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1301.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KCl 40 MEQ/L (0.3%) in NaCl 0.9% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338069504", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ASSAY OF VITAMIN B-6", "code_information": [ { "code": "84207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 643.75, "discounted_cash": 28.0, "minimum": 27.3076, "maximum": 561.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 125.61, "10th_percentile": 125.61, "90th_percentile": 125.61, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.13, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.31, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 346.44, "10th_percentile": 346.44, "90th_percentile": 353.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 449.08, "10th_percentile": 449.08, "90th_percentile": 453.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL", "code_information": [ { "code": "0823T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71516.9, "discounted_cash": 21947.0, "minimum": 21455.07, "maximum": 71516.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71516.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71516.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71516.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23923.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21947.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37118.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6211) FOAM DRG > 48 SQ IN W/O BRDR", "code_information": [ { "code": "A6211", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 41.0, "minimum": 40.6795, "maximum": 70.7936, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.86, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.85, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.68, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 41.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 41.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 41.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.79, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NUCLEAR THERAPY, UNLISTED", "code_information": [ { "code": "79999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1661.88, "discounted_cash": 230.0, "minimum": 230.23, "maximum": 1449.1594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 907.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1101.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 881.48, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 389.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1893) INTRDUCR/SHEATH EP CURVE NOT PEEL", "code_information": [ { "code": "C1893", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 757.34, "10th_percentile": 757.34, "90th_percentile": 757.34, "count": "1 through 10" } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "328", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13234.0, "minimum": 11029.14, "maximum": 38464.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 33967.95, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 25837.85, "10th_percentile": 25837.85, "90th_percentile": 25837.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12741.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28953.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12741.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12741.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38464.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13234.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11029.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13234.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38464.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12741.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13234.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12741.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17820.27 } ] } ] }, { "description": "HC (SUP SHELL A6254) ABSORPT DRG <=16 SQ IN W/BDR - A6254 - RU272056", "code_information": [ { "code": "A6254", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.6521, "maximum": 2.875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.65, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine HCl Preservative Free (PF) Inj 0.5%", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "00143933401", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC DRAIN/INJECT INTERMEDIATE JOINT/BURSA", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 443.44, "discounted_cash": 302.0, "minimum": 133.032, "maximum": 443.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1297.77, "10th_percentile": 1297.77, "90th_percentile": 1297.77, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 443.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FETAL BLEED SCREEN, KLEIHAUER-BETKE", "code_information": [ { "code": "85460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 394.06, "discounted_cash": 7.0, "minimum": 7.512, "maximum": 343.6203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 34.55, "10th_percentile": 34.55, "90th_percentile": 34.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.39, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 212.07, "10th_percentile": 212.07, "90th_percentile": 212.07, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ENTAMOEB HIST GROUP AG EIA", "code_information": [ { "code": "87337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.13, "discounted_cash": 11.0, "minimum": 11.6422, "maximum": 172.7694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL - 84153 - 30100312", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.25, "discounted_cash": 18.0, "minimum": 17.8714, "maximum": 201.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 148.0, "10th_percentile": 148.0, "90th_percentile": 148.0, "count": "40" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 22.34, "10th_percentile": 22.34, "90th_percentile": 22.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 35.18, "10th_percentile": 35.18, "90th_percentile": 117.85, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 124.45, "10th_percentile": 124.45, "90th_percentile": 126.84, "count": "87" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 82.2, "10th_percentile": 82.2, "90th_percentile": 148.0, "count": "30" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 96.5, "10th_percentile": 96.5, "90th_percentile": 96.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL - C8908 - 61077049", "code_information": [ { "code": "C8908", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1173.75, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1173.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1173.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1173.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1173.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT ANGIO,LOWER EXTREM,COMBO,IMAGE PRC", "code_information": [ { "code": "73706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2101.25, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2101.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 724.9, "10th_percentile": 724.9, "90th_percentile": 724.9, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2101.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3900) HINGE EXTENSION/FLEX WRIST/F", "code_information": [ { "code": "L3900", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1462.0, "minimum": 1421.6851, "maximum": 2474.1241, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1462.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1462.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1777.03, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1462.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1421.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1462.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1462.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1462.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1594.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1462.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1462.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1462.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1462.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1462.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2474.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM LIVER AND SPLEEN IMAGING", "code_information": [ { "code": "78215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 984.06, "discounted_cash": 394.0, "minimum": 295.218, "maximum": 984.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 984.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 984.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 984.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 984.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED PROCEDURE SPINE", "code_information": [ { "code": "22899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 640.63, "discounted_cash": 243.0, "minimum": 192.189, "maximum": 640.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 640.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 640.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 640.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Nitroglycerin IV Soln 100 MCG/ML in D5W", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "00338104702", "type": "NDC" }, { "code": "J2305", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.881, "maximum": 2.881, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.88 } ] } ] }, { "description": "HC INSERT,TEMP INDWELLING BLAD CATH,COMP", "code_information": [ { "code": "51703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 531.25, "discounted_cash": 126.0, "minimum": 126.95, "maximum": 531.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 500.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 531.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 486.05, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPLACE CV CATH CMPLT TUNNLD W SUBQ PORT/PUMP", "code_information": [ { "code": "36583", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8962.19, "discounted_cash": 5490.0, "minimum": 2688.657, "maximum": 8962.19, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8962.19, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8962.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8962.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8962.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL", "code_information": [ { "code": "86592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.56, "discounted_cash": 4.0, "minimum": 4.1496, "maximum": 97.2803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 67.4, "10th_percentile": 19.09, "90th_percentile": 67.4, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 56.85, "10th_percentile": 53.67, "90th_percentile": 56.85, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 60.04, "10th_percentile": 57.76, "90th_percentile": 60.04, "count": "24" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 19.09, "10th_percentile": 19.09, "90th_percentile": 19.09, "count": "11" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 77.83, "10th_percentile": 22.41, "90th_percentile": 77.83, "count": "70" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT INDWEL TUNNELED PLEURAL CATH W CUFF", "code_information": [ { "code": "32550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1014.38, "discounted_cash": 3532.0, "minimum": 304.314, "maximum": 1014.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fosaprepitant Dimeglumine For IV Infusion 150 MG (Base Eq)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "31722016531", "type": "NDC" }, { "code": "J1453", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 251.33, "10th_percentile": 251.33, "90th_percentile": 251.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 309.45, "10th_percentile": 93.31, "90th_percentile": 309.45, "count": "1 through 10" } ] } ] }, { "description": "HC SCLEROTHERAPY FLUID COLLECTION PRQ W/ IMG GDN", "code_information": [ { "code": "49185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3703.13, "discounted_cash": 1629.0, "minimum": 1110.939, "maximum": 3703.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3703.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3703.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3703.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1921.33, "10th_percentile": 313.3, "90th_percentile": 2234.63, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Rituximab-abbs IV Soln 100 MG/10ML (10 MG/ML)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63459010310", "type": "NDC" }, { "code": "Q5115", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 31.0, "minimum": 28.5515, "maximum": 123.2228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 123.22, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.55, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 3584.5, "10th_percentile": 3449.03, "90th_percentile": 12645.31, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECT RX CELIAC PLEXUS NERVE", "code_information": [ { "code": "64680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695.31, "discounted_cash": 872.0, "minimum": 208.593, "maximum": 695.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 695.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13388.0, "minimum": 11152.34, "maximum": 63467.9375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12889.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29320.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12889.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12889.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44186.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11152.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44186.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12889.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13388.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12889.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18046.04 } ] } ] }, { "description": "HC INJ, THERAP/PROPH/DIAGN, IV PUSH EA ADD SAME DX", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.94, "minimum": 123.282, "maximum": 358.3397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 441.84, "10th_percentile": 220.92, "90th_percentile": 441.84, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 242.9, "10th_percentile": 242.9, "90th_percentile": 728.71, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 520.74, "10th_percentile": 520.74, "90th_percentile": 520.74, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4112) CYMETRA INJECTABLE", "code_information": [ { "code": "Q4112", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1874.972, "maximum": 1874.972, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1874.97 } ] } ] }, { "description": "HC DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD", "code_information": [ { "code": "93985", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1248.44, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1126.6495, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CCMCC", "code_information": [ { "code": "575", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14714.0, "minimum": 13819.82, "maximum": 38863.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14162.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32471.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14162.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14162.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38863.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14714.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13819.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14714.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38863.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14162.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14714.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14162.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19985.66 } ] } ] }, { "description": "HC QUANT DIFF PULM PRFUSION & VENT W/WO IMG", "code_information": [ { "code": "78598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1392.81, "discounted_cash": 535.0, "minimum": 417.843, "maximum": 1392.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1392.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1392.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1392.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1392.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, FACE, NECK W/CONTRAST", "code_information": [ { "code": "70542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2434.38, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2122.7794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1757.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "301", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6521.0, "minimum": 4937.68, "maximum": 22202.5675, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6300.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13004.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6300.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6300.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12691.54 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6521.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4937.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6521.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12691.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6300.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6521.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6300.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8004.27 } ] } ] }, { "description": "Insulin Glargine Inj 100 Unit/ML", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00088221901", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A6231) HYDROGEL DSG<=16 SQ IN", "code_information": [ { "code": "A6231", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.4722, "maximum": 11.2634, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Acetazolamide Sodium For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "67457085350", "type": "NDC" }, { "code": "J1120", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 40.979, "maximum": 40.979, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.98 } ] } ] }, { "description": "Iopamidol IV Soln 61%", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00270131535", "type": "NDC" }, { "code": "Q9967", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 50.78, "10th_percentile": 50.78, "90th_percentile": 50.78, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC MAMMOGRAM, SCREENING", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 667.5, "discounted_cash": 83.0, "minimum": 81.4271, "maximum": 582.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 427.2, "10th_percentile": 427.2, "90th_percentile": 427.2, "count": "173" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.78, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 95.73, "10th_percentile": 95.73, "90th_percentile": 95.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 338.56, "10th_percentile": 338.56, "90th_percentile": 469.92, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 415.13, "10th_percentile": 407.28, "90th_percentile": 415.13, "count": "267" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 297.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 365.29, "10th_percentile": 365.29, "90th_percentile": 427.2, "count": "79" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 297.79, "10th_percentile": 297.79, "90th_percentile": 469.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 141.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SARS-COV-2 COVID-19 AMP PRB - U0002 - 30087635", "code_information": [ { "code": "U0002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.5, "discounted_cash": 51.0, "minimum": 49.8631, "maximum": 182.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.33, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.86, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 182.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC GENERAL HEALTH PANEL", "code_information": [ { "code": "80050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 720.63, "minimum": 216.189, "maximum": 628.3894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 430.65, "10th_percentile": 430.65, "90th_percentile": 430.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.15 } ] } ] }, { "description": "HC X-RAY LUMBAR SPINE 4 VW", "code_information": [ { "code": "72110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 879.38, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 766.8194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 155.38, "10th_percentile": 155.38, "90th_percentile": 161.28, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 446.02, "10th_percentile": 446.02, "90th_percentile": 446.02, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 536.56, "10th_percentile": 516.0, "90th_percentile": 536.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 613.45, "10th_percentile": 613.45, "90th_percentile": 613.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Morphine Sulfate Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641612701", "type": "NDC" }, { "code": "J2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.9545, "maximum": 9.9545, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 47.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 14.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "HC ECHO HEART XTHORACIC,COMPLETE W DOPPLER", "code_information": [ { "code": "93306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3168.75, "discounted_cash": 539.0, "minimum": 539.15, "maximum": 2763.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2028.0, "10th_percentile": 1703.52, "90th_percentile": 2028.0, "count": "14" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2124.04, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2580.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2064.24, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 1934.21, "10th_percentile": 1934.21, "90th_percentile": 3868.42, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1933.44, "10th_percentile": 1933.44, "90th_percentile": 1970.71, "count": "25" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1943.33, "10th_percentile": 1943.33, "90th_percentile": 1973.99, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1989.98, "10th_percentile": 1989.98, "90th_percentile": 2007.72, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 587.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2210.52, "10th_percentile": 1943.33, "90th_percentile": 2230.8, "count": "42" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 911.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10148.0, "minimum": 8051.58, "maximum": 25272.9878, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9780.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21622.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9780.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9780.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24408.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10148.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8051.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10148.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24408.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9780.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10148.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9780.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13308.2 } ] } ] }, { "description": "HC VENOGRAM HEPATIC", "code_information": [ { "code": "75891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7608.44, "discounted_cash": 3115.0, "minimum": 640.6242, "maximum": 7608.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7608.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7608.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7608.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BARTONELLA, ANTIBODY", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.19, "discounted_cash": 10.0, "minimum": 9.8929, "maximum": 62.9497, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.22, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PROLACTIN", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.81, "discounted_cash": 19.0, "minimum": 18.8335, "maximum": 211.7303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 130.54, "10th_percentile": 130.54, "90th_percentile": 155.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.54, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 123.74, "10th_percentile": 123.74, "90th_percentile": 123.74, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 133.18, "10th_percentile": 130.67, "90th_percentile": 133.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 169.39, "10th_percentile": 101.69, "90th_percentile": 170.94, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY FISTULA,ABSCESS,SINUS TRACT", "code_information": [ { "code": "76080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 995.63, "discounted_cash": 539.0, "minimum": 298.689, "maximum": 995.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 995.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 995.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 995.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 310.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 587.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 911.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8434.0, "minimum": 6690.85, "maximum": 17771.476, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8135.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17549.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8135.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8135.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13503.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8434.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6690.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8434.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13504.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8135.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8434.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8135.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10801.38 } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "033", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13695.0, "minimum": 11042.98, "maximum": 34680.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13183.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30048.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13183.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13183.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34680.57 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13695.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11042.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13695.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34680.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13183.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13695.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13183.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18494.24 } ] } ] }, { "description": "HC REVSC EVASC FPVT ANGIOP UNI CPLX LES 1ST VSL", "code_information": [ { "code": "37265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27547.8, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 26875.9169, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22124.32, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26875.92, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4565) SLINGS - A4565 - 27400063", "code_information": [ { "code": "A4565", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 10.6704, "maximum": 18.5694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TOBACCO CESSATION ASYMPTOMATIC >10 MIN", "code_information": [ { "code": "99407", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.5, "discounted_cash": 36.0, "minimum": 35.25, "maximum": 117.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 117.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For IV Soln 3 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567084501", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7845, "maximum": 1.7845, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.87, "10th_percentile": 11.99, "90th_percentile": 26.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.78 } ] } ] }, { "description": "HC (SUP SHELL A7015) AEROSOL MASK USED W NEBULIZE", "code_information": [ { "code": "A7015", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.5063, "maximum": 2.6214, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.88, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.51, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.62, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY NEOPLASMS WITHOUT CCMCC", "code_information": [ { "code": "182", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6780.0, "minimum": 5796.61, "maximum": 16301.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6549.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13621.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6549.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6549.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16301.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6780.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5796.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6780.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16301.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6549.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6780.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6549.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8383.52 } ] } ] }, { "description": "HC ASSAY OF DIGOXIN", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.44, "discounted_cash": 13.0, "minimum": 12.9055, "maximum": 155.5997, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 59.36, "10th_percentile": 59.36, "90th_percentile": 59.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 96.03, "10th_percentile": 96.03, "90th_percentile": 96.03, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 59.36, "10th_percentile": 59.36, "90th_percentile": 59.36, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 69.68, "10th_percentile": 69.68, "90th_percentile": 69.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6011) COLLAGEN GEL/PASTE WOUND FIL", "code_information": [ { "code": "A6011", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.1583, "maximum": 5.4964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECT NERV BLCK,SPHENOPALAT GANGLN", "code_information": [ { "code": "64505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1103.13, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1103.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1103.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1103.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1103.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIFFUSING CAPACITY", "code_information": [ { "code": "94729", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 363.75, "minimum": 109.125, "maximum": 317.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 221.8, "10th_percentile": 221.8, "90th_percentile": 221.8, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 213.21, "10th_percentile": 213.21, "90th_percentile": 213.21, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 221.95, "10th_percentile": 215.53, "90th_percentile": 221.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 212.54, "10th_percentile": 212.54, "90th_percentile": 223.08, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 219.58, "10th_percentile": 219.58, "90th_percentile": 219.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 243.98, "10th_percentile": 243.98, "90th_percentile": 253.75, "count": "11" } ] } ] }, { "description": "HC PROTEIN E-PHORESIS/URINE/CSF", "code_information": [ { "code": "84166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.63, "discounted_cash": 17.0, "minimum": 17.3272, "maximum": 240.3494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hepatitis B Immune Globulin (Human) IM Soln 312 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "49591005251", "type": "NDC" }, { "code": "90371", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 140.0, "minimum": 130.4058, "maximum": 552.3674, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 552.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 163.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 130.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 307.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 140.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 140.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 140.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 140.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 140.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BX BREAST W DEVICE US GUIDE ADDL LESION", "code_information": [ { "code": "19084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2571.25, "minimum": 771.375, "maximum": 2242.13, "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1559.25, "10th_percentile": 1559.25, "90th_percentile": 1559.25, "count": "1 through 10" } ] } ] }, { "description": "HC OCCUP THRP EVAL, LOW COMPLEXITY, 30 MIN", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 626.88, "discounted_cash": 96.0, "minimum": 93.7884, "maximum": 546.6394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 337.01, "10th_percentile": 337.01, "90th_percentile": 337.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.79, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 382.49, "10th_percentile": 382.49, "90th_percentile": 382.49, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 384.45, "10th_percentile": 384.45, "90th_percentile": 384.45, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 437.31, "10th_percentile": 384.45, "90th_percentile": 441.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY", "code_information": [ { "code": "884", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13284.0, "minimum": 11560.01, "maximum": 37162.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12789.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29072.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12789.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12789.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37162.76 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13284.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11560.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13284.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37162.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12789.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13284.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12789.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17893.67 } ] } ] }, { "description": "HC CHROMOSOME ANALYSIS:20-25", "code_information": [ { "code": "88264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1103.75, "discounted_cash": 144.0, "minimum": 140.532, "maximum": 962.47, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.66, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.53, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 758.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 769.98, "10th_percentile": 769.98, "90th_percentile": 769.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 244.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BX BREAST W DEVICE STEREOTACT GUIDE 1ST LESION", "code_information": [ { "code": "19081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5091.25, "discounted_cash": 1629.0, "minimum": 1527.375, "maximum": 5091.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5091.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5091.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5091.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION", "code_information": [ { "code": "10005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3806.25, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 3343.8164, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3343.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 2254.46, "10th_percentile": 2254.46, "90th_percentile": 2254.46, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITH CC", "code_information": [ { "code": "501", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14343.0, "minimum": 12352.5, "maximum": 42410.1982, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36909.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13805.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14343.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13805.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19441.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13805.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31587.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13805.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13805.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36909.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14343.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12352.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14343.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD TRANSFUSION SERVICE", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1605.63, "discounted_cash": 435.0, "minimum": 435.31, "maximum": 1605.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 822.02, "10th_percentile": 822.02, "90th_percentile": 822.02, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1605.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1605.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1605.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 937.74, "10th_percentile": 937.74, "90th_percentile": 984.7, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 474.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1120.08, "10th_percentile": 851.8, "90th_percentile": 1120.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 736.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CREATININE CLEARANCE TEST", "code_information": [ { "code": "82575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.38, "discounted_cash": 9.0, "minimum": 9.1932, "maximum": 204.3794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 165.0, "10th_percentile": 165.0, "90th_percentile": 165.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK", "code_information": [ { "code": "67935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8690.63, "discounted_cash": 2345.0, "minimum": 2345.87, "maximum": 8690.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8690.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8690.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8690.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2557.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3967.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NASAL ENDO SX,CONTROL OF NASAL HEMORRHAGE", "code_information": [ { "code": "31238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7972.81, "discounted_cash": 1756.0, "minimum": 1756.22, "maximum": 7972.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6918.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7972.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6724.04, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2970.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE", "code_information": [ { "code": "76770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1185.94, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1034.1397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 288.36, "10th_percentile": 288.36, "90th_percentile": 296.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 695.77, "10th_percentile": 695.77, "90th_percentile": 723.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 646.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 727.31, "10th_percentile": 727.31, "90th_percentile": 827.31, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15264.0, "minimum": 12146.93, "maximum": 40765.2442, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14689.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33776.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14689.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14689.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32728.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12146.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32728.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14689.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15264.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14689.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20788.64 } ] } ] }, { "description": "HC PROTEIN, WESTERN BLOT TEST, W BAND ID", "code_information": [ { "code": "84182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 602.19, "discounted_cash": 29.0, "minimum": 28.3863, "maximum": 525.1097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 520.58, "10th_percentile": 520.58, "90th_percentile": 520.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ED LEVEL 5", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3182.19, "discounted_cash": 587.0, "minimum": 587.61, "maximum": 2812.1252, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1487.64, "10th_percentile": 285.46, "90th_percentile": 1753.29, "count": "20" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2314.95, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2812.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2249.78, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 1880.99, "10th_percentile": 1880.99, "90th_percentile": 2219.9, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1720.97, "10th_percentile": 1720.97, "90th_percentile": 1941.64, "count": "65" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1951.57, "10th_percentile": 1697.06, "90th_percentile": 2841.21, "count": "72" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1753.29, "10th_percentile": 1487.64, "90th_percentile": 1998.41, "count": "17" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 640.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2219.89, "10th_percentile": 1697.06, "90th_percentile": 2219.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 587.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 993.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITH MCC", "code_information": [ { "code": "619", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23007.0, "minimum": 18871.01, "maximum": 84264.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22119.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 52174.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22119.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22119.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 84264.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18871.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 84264.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22119.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 23007.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22119.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32112.74 } ] } ] }, { "description": "Hydroxyzine HCl Syrup 10 MG/5ML", "drug_information": { "unit": 473.0, "type": "ML" }, "code_information": [ { "code": "54838050280", "type": "NDC" }, { "code": "Q0177", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL C1725) CATHETER TRNSLUM ANGPLSTY NON-LASER", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 24.91, "10th_percentile": 24.91, "90th_percentile": 5395.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 463.69, "10th_percentile": 463.69, "90th_percentile": 463.69, "count": "1 through 10" } ] } ] }, { "description": "HC GASTRIC INTUBATION/ASPIRATION, THERAPEUTIC", "code_information": [ { "code": "43753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.06, "discounted_cash": 213.0, "minimum": 100.218, "maximum": 334.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 334.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 334.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 334.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS", "code_information": [ { "code": "36595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1137.5, "discounted_cash": 3115.0, "minimum": 341.25, "maximum": 1137.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1137.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI GUIDANCE NEEDLE PLACEMENT", "code_information": [ { "code": "77021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1250.0, "minimum": 375.0, "maximum": 1250.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1250.0 } ] } ] }, { "description": "HC ENZYME HISTOCHEMISTRY", "code_information": [ { "code": "88319", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.75, "discounted_cash": 794.0, "minimum": 68.625, "maximum": 228.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 228.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EXAM,SYNOVIAL FLUID CRYSTALS", "code_information": [ { "code": "89060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.31, "discounted_cash": 7.0, "minimum": 7.1233, "maximum": 109.2703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 75.6, "10th_percentile": 75.6, "90th_percentile": 75.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 63.86, "10th_percentile": 63.86, "90th_percentile": 63.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 87.42, "10th_percentile": 87.42, "90th_percentile": 87.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI LOWER EXTREM W/CONTRAST", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2698.75, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2353.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1711.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD CLOT FACTOR XII TEST", "code_information": [ { "code": "85280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360.31, "discounted_cash": 19.0, "minimum": 18.8043, "maximum": 314.1903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RADIOTHERAPY", "code_information": [ { "code": "849", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21654.0, "minimum": 18487.56, "maximum": 58596.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20821.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 48960.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20821.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20821.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 58596.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21654.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18487.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21654.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58596.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20821.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21654.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20821.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30134.19 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 59444.0, "minimum": 53553.79, "maximum": 166418.3355, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 57082.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 138745.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 57082.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 57082.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 133520.2 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 59444.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53553.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 59444.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 133520.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 57082.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 59444.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 57082.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 85395.6 } ] } ] }, { "description": "HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ", "code_information": [ { "code": "87636", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 568.13, "discounted_cash": 142.0, "minimum": 138.6078, "maximum": 568.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 343.0, "10th_percentile": 288.12, "90th_percentile": 343.0, "count": "20" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 173.25, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 138.61, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 904.34, "10th_percentile": 904.34, "90th_percentile": 904.34, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 293.95, "10th_percentile": 293.95, "90th_percentile": 305.74, "count": "21" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 339.57, "10th_percentile": 86.53, "90th_percentile": 356.78, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 377.3, "10th_percentile": 377.3, "90th_percentile": 748.41, "count": "50" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 241.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TRAUMA HIP DISLOC W ANES", "code_information": [ { "code": "27252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6331.25, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 6331.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6250.61, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6331.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6074.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SALIVARY GLAND IMAGING", "code_information": [ { "code": "78230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 947.19, "discounted_cash": 394.0, "minimum": 284.157, "maximum": 947.19, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 947.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 947.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 947.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 947.19, "additional_payer_notes": "382.87% of Medicare Rates" } ] } ] }, { "description": "HC DNA ANTIBODY, NATV/2 STRAND", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 13.0, "minimum": 13.3525, "maximum": 156.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 115.2, "10th_percentile": 96.77, "90th_percentile": 115.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 97.3, "10th_percentile": 91.73, "90th_percentile": 97.3, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 102.75, "10th_percentile": 98.73, "90th_percentile": 197.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 126.72, "10th_percentile": 126.72, "90th_percentile": 133.2, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EEG EXTENDED MONITORING 61-119 MINUTES", "code_information": [ { "code": "95813", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1135.63, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1019.5934, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC", "code_information": [ { "code": "069", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7123.0, "minimum": 5537.76, "maximum": 20515.0358, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6877.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14434.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6877.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6877.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16147.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7123.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5537.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7123.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16147.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6877.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7123.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6877.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8884.0 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17607.0, "minimum": 14510.57, "maximum": 57445.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16937.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39343.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16937.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16937.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 57445.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17607.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14510.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57445.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16937.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17607.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16937.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24215.23 } ] } ] }, { "description": "HC CONTROL NOSE BLEED ANTER COMPLEX", "code_information": [ { "code": "30903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 458.75, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 458.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VANCOMYCIN", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 447.81, "discounted_cash": 13.0, "minimum": 13.1582, "maximum": 390.4903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR CV CATH W SUBQ PORT OR PUMP", "code_information": [ { "code": "36576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3470.0, "discounted_cash": 1553.0, "minimum": 1041.0, "maximum": 3470.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3470.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3470.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3470.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEXA,BONE DENSITY, 1 + SITE, AXIAL SKELETON", "code_information": [ { "code": "77080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 827.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 721.8503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 499.8, "10th_percentile": 499.8, "90th_percentile": 499.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 396.09, "10th_percentile": 396.09, "90th_percentile": 419.87, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 485.68, "10th_percentile": 485.68, "90th_percentile": 505.1, "count": "23" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 118.41, "10th_percentile": 118.41, "90th_percentile": 499.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 262.82, "10th_percentile": 262.82, "90th_percentile": 262.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NATRIURETIC PEPTIDE", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.13, "discounted_cash": 39.0, "minimum": 38.1529, "maximum": 582.6094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 427.6, "10th_percentile": 359.18, "90th_percentile": 427.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.69, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 340.48, "10th_percentile": 340.48, "90th_percentile": 340.48, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 366.45, "10th_percentile": 359.56, "90th_percentile": 366.45, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 206.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 175.49, "10th_percentile": 175.49, "90th_percentile": 427.6, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 466.08, "10th_percentile": 466.08, "90th_percentile": 470.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methotrexate Sodium Tab 2.5 MG (Base Equiv)", "drug_information": { "unit": 20.0, "type": "EA" }, "code_information": [ { "code": "00904714110", "type": "NDC" }, { "code": "J8610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ECHO HEART,TRANSESOPH,PROBE PLACEMT", "code_information": [ { "code": "93313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2553.13, "discounted_cash": 539.0, "minimum": 539.15, "maximum": 2553.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2124.04, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2553.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2064.24, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 587.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 911.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Clindamycin Phosphate in D5W IV Soln 300 MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00781328891", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.4615, "maximum": 3.4615, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.46 } ] } ] }, { "description": "HC ELEC STIM OTHER THAN WOUND - 97014 - 42000014", "code_information": [ { "code": "97014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.63, "minimum": 24.189, "maximum": 80.63, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.63 } ] } ] }, { "description": "HC US EXAM, HYSTEROSONOGRAPHY", "code_information": [ { "code": "76831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1096.56, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1096.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1096.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 722.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53357.0, "minimum": 34848.1, "maximum": 215129.6049, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 124282.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34848.12 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 53357.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46148.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53357.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34848.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 53357.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 76493.8 } ] } ] }, { "description": "HC CLSD TREAT ULNAR XF PROX END WO MANIP", "code_information": [ { "code": "24670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 470.63, "discounted_cash": 243.0, "minimum": 141.189, "maximum": 470.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 470.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 470.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 470.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Insulin NPH (Human) (Isophane) Inj 100 Unit/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00002831501", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CYTO/MOLECULAR REPORT", "code_information": [ { "code": "88291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.63, "minimum": 114.189, "maximum": 331.9094, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.66 } ] } ] }, { "description": "Cefoxitin Sodium For IV Soln 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00143987701", "type": "NDC" }, { "code": "J0694", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.7715, "maximum": 10.7715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 73.24, "10th_percentile": 73.24, "90th_percentile": 73.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.77 } ] } ] }, { "description": "HC (SUP SHELL A5051) POUCH CLSD W BARR ATTACHED", "code_information": [ { "code": "A5051", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.8571, "maximum": 4.9721, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.57, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.86, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CARDIOVERSION, ELECTIVE;EXTERN", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1347.5, "discounted_cash": 652.0, "minimum": 404.25, "maximum": 1347.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 778.92, "10th_percentile": 778.92, "90th_percentile": 778.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1347.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1347.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1347.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 543.88, "10th_percentile": 543.88, "90th_percentile": 543.88, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 791.59, "10th_percentile": 791.59, "90th_percentile": 820.28, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 840.19, "10th_percentile": 840.19, "90th_percentile": 840.19, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 710.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 622.38, "10th_percentile": 622.38, "90th_percentile": 964.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1102.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM - C9600 - 48193724", "code_information": [ { "code": "C9600", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.25, "discounted_cash": 11390.0, "minimum": 52.875, "maximum": 27387.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 15499.44, "10th_percentile": 15499.44, "90th_percentile": 15499.44, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC APPLY LONG ARM CAST", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 370.31, "discounted_cash": 275.0, "minimum": 111.093, "maximum": 370.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 370.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 370.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 370.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 275.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 370.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hydroxyzine HCl Tab 10 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60687066411", "type": "NDC" }, { "code": "Q0177", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC COLD STORED PLATELETS PSORALEN TREATED", "code_information": [ { "code": "P9073", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3839.69, "discounted_cash": 604.0, "minimum": 604.45, "maximum": 3348.2097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2381.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2892.72, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2314.26, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 658.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1022.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 150 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00955101510", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.118, "maximum": 1.118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.12 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4258) ENVERSE, PER SQ CM", "code_information": [ { "code": "Q4258", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC PERCUT REMV KID STONE,UP TO 2 CM", "code_information": [ { "code": "50080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10545.9, "discounted_cash": 9340.0, "minimum": 3163.77, "maximum": 10545.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9340.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10545.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10545.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9340.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10545.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9340.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9340.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9340.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10181.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9340.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9340.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9340.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9340.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9340.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10545.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3906) WHO W/O JOINTS CF", "code_information": [ { "code": "L3906", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 527.0, "minimum": 512.6245, "maximum": 892.108, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 527.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 527.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 640.75, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 527.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 512.62, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 527.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 527.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 527.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 574.98, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 527.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 527.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 527.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 527.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 527.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 892.11, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00006483701", "type": "NDC" }, { "code": "90732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 129.7061, "maximum": 286.982, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 129.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 286.98 } ] } ] }, { "description": "HC ASSAY OF ESTROGENS", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 438.13, "discounted_cash": 32.0, "minimum": 31.3891, "maximum": 382.0494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 280.4, "10th_percentile": 280.4, "90th_percentile": 280.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.23, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.39, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 240.3, "10th_percentile": 240.3, "90th_percentile": 240.3, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 305.64, "10th_percentile": 305.64, "90th_percentile": 305.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN DEBRIDEMENT WITH CC", "code_information": [ { "code": "571", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13897.0, "minimum": 11588.38, "maximum": 39866.6388, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13377.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30528.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13377.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13377.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29077.12 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13897.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11588.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13897.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29077.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13377.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13897.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13377.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18790.08 } ] } ] }, { "description": "HC (SUP SHELL C1730) CATH, EP, 19 OR FEW ELECT", "code_information": [ { "code": "C1730", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 257.88, "10th_percentile": 257.88, "90th_percentile": 257.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1438.14, "10th_percentile": 1438.14, "90th_percentile": 1438.14, "count": "1 through 10" } ] } ] }, { "description": "HC BILIRUBIN TOTAL", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.88, "discounted_cash": 5.0, "minimum": 4.8784, "maximum": 145.5194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 33.4, "10th_percentile": 12.6, "90th_percentile": 40.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 31.85, "10th_percentile": 26.59, "90th_percentile": 85.04, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 89.81, "10th_percentile": 28.62, "90th_percentile": 91.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 22.44, "10th_percentile": 0.97, "90th_percentile": 33.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 36.74, "10th_percentile": 26.34, "90th_percentile": 116.41, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFTS FOR INJURIES WITH CCMCC", "code_information": [ { "code": "904", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28983.0, "minimum": 26723.95, "maximum": 66372.3293, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27853.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 66372.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27853.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27853.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 61374.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28983.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26723.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28983.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 61374.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27853.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28983.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27853.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40851.04 } ] } ] }, { "description": "HC FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION", "code_information": [ { "code": "10007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3806.25, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 3343.8164, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3343.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Terbutaline Sulfate Inj 1 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00143974601", "type": "NDC" }, { "code": "J3105", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.0315, "maximum": 3.0315, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.03 } ] } ] }, { "description": "HC NM BONE IMAGING, MULTIPLE AREAS", "code_information": [ { "code": "78305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 874.38, "discounted_cash": 394.0, "minimum": 262.314, "maximum": 874.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 874.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 874.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 874.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] } ] }